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Am Fam Physician. 2007;75(7):1073-1074

Background: Despite guidelines that call for more judicious and limited use, physicians often prescribe antibiotics for pharyngitis and report pressure from patients to receive them. Van Driel and colleagues assessed what patients considered important during an office visit for the treatment of pharyngitis, and whether other factors could be attributed to those who wanted or thought they needed an antibiotic.

The Study: Six family physician group practices were randomly selected from two Belgian provinces to participate in this cross-sectional questionnaire survey. During a six-week period, the physicians enrolled consecutive patients who were 12 years or older and who presented with an acute sore throat. Patients completed confidential and anonymous questionnaires in the waiting room immediately after their visit.

The questionnaires asked patients to rank 13 reasons for visiting their family physician that day. Eight questions came from previously validated surveys. The remaining statements were specific to pharyngitis and included the desire for pain relief, an antibiotic, or an excuse for missing work or school; and information about possible treatments and expected illness duration. Patients also rated their disease severity and their knowledge and beliefs about the role of antibiotics.

Results: Patient demographics were sex balanced and reflected a range of ages, employment status, and level of education completed. In the 298 completed questionnaires, the top-ranking items included establishing a cause for symptoms, obtaining pain relief, and gaining information on the course of the illness. More than 80 percent of patients listed these as very or rather important. The desire for an antibiotic ranked 11th out of the 13 items, and 37.6 percent of patients ranked it as very or rather important.

Although this ranking remained the same between both groups, participants who considered antibiotic use as very or rather important rated pain relief significantly higher than those who did not consider antibiotic use important. Patients who wanted an antibiotic felt more severely ill and were less likely to believe that frequent antibiotic use could be harmful to their personal health or to public health. In a bivariate analysis, the desire for pain relief was a strong predictor of the desire for an antibiotic.

Conclusion: Pain relief was a major motivator for patients with pharyngitis. It was a greater concern for those who wanted antibiotics. Although these results suggest that adequately treating pain may be more effective in addressing patient concerns than prescribing an antibiotic, the authors' review of the literature did not reveal any studies that compared antibiotic use and adequate analgesia with pain relief as the primary end point.

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