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Question answered:22/08/07 Warning! this question is over two years old.
We found two recent secondary reviews, both of which suggest that antibiotics are unnecessary for most patients. However, the rationale behind a particular duration of treatment seems guided by the duration of antibiotics used in RCTs.
The CKS (formerly PRODIGY) guideline on sore throat [1] includes this comment:
“Phenoxymethylpenicillin, and erythromycin (for those with penicillin allergy): 10-day treatment has been used in most studies and is recommended in order to eradicate possible streptococcus infection. However, shorter courses may be appropriate, as there is no good correlation between microbiological and clinical cure for relief of symptoms. The Health Protection Agency recommends either twice- or four-times-daily dosing, lasting 7–10 days for penicillin and 5–10 days for erythromycin. As it is difficult to recommend any one particular regimen, CKS offers twice- or four-times-daily dosing for 7 or 10 days.”
MeReC, in their bulletin on sore throat [2] report:
“Antibiotic treatment — which drug, dose and duration?
For adult patients who need an antibiotic, phenoxymethylpenicillin 500mg two to four times daily for 10 days is an appropriate first choice. Erythromycin 500mg twice daily or 250mg four times daily for 10 days is an alternative for those who are allergic to penicillin. Lower doses will be required for children.”
References
1) http://cks.library.nhs.uk/sore_throat_acute/view_whole_guidance
2) http://www.npc.co.uk/MeReC_Bulletins/pdfs/Sore_throat_Final.pdf
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