A sore throat can be a mild pain or a severe throat bursting pain and it becomes a dilemma for both doctors and patients equally as far as antibiotic prescription is concerned. In this era of evidence-based practice a throat swab culture would be non-indicative of bacterial etiology in majority of cases thereby suggesting a viral cause. And evidence still says there is just a marginal or even negligible benefit with anti-biotic. It should otherwise be a self-limiting one, which should go away with some saline gurgle and throat lozenges. Then why is this prescription of anti-biotic? For today let us pick up this thread and see this dilemma through the lenses of both the provider (the doctors) and the client (patient)

Doctors who go for antibiotics.

These doctors say that when they suspect bacterial cause (streptococcus to be precise) they have to go for the antibiotic-the penicillin (commonly the Amoxycillin). A strep infection can trigger an immune response and during the battle one's own immune system jawan could injure one's own tissues. These tissues are mainly the slippery synovial membrane in the joints and the tissue in the heart thereby giving us the disease called Rheumatic fever.

Well in simple terms it is somewhat like the Americans started attacking all turbaned people after the 9/11 incident. They started seeing a brother of Osama in all of them. So this harmful and dangerous game of hide-and-seek does happen in nature too. Therefore these doctors say a short course of anti-biotic could provide a good shield and give this as the main reason for anti-biotic prescription.

Doctors who don't go for antibiotics

Yet there are many who say no claiming the marginal or even negligent benefit with the anti-biotic. The slogan with them is " with antibiotic you get well in 7 days and without it takes a week, the choice is therefore yours." So these doctors may possibly tend to say that " its just viral it will go away." Do you thing this divide into 'yes' and 'no' antibiotic doctors is all? It isn't.

There are many things behind the anti-biotic drama. Antibiotics are still prescribed by many doctors for other reasons-interesting reasons. One such main reason is "you" the patient not for the sore throat but for maintenance of a good patient-doctor relationship. Hard to believe but believe it.

The patient's lens

Before we get into hard facts just try to remember the occasion when you last met the friendly or not so friendly family doctor who just listened and without giving much attention said "its just viral." Were you satisfied and carried on for a long week to get well? I can hear some yes but I can hear a lot more no's who grumbles, " Well he wasn't just concerned."

It is also still likely that you went to another doctor for the sore throat and got settled in just 7 days with his antibiotic and also that you vowed not to visit the earlier doctor whenever you should fall sick again. So it was you who expected the antibiotic in many of the cases. Studies done through interviews of both doctors and the patients have revealed this.

On the other hand doctors who are against the anti-biotic still prescribe them because of some bad experience. "Try explaining the viral etiology and the uselessness of anti-biotic and the risk of bacterial developing resistance to the antibiotic seeking patient you would end up wasting some 15 mins. You could finish the patient interview in 3-4 mins if you give the anti-biotic," revolt these doctors. Whew! So to maintain a good patient-doctor relationship some antibiotic are prescribed.

So where is the light at the end of the tunnel

So, to regulate this behavior, in developed countries the focus is on the patient mainly. It is only when they start understanding this dilemma. (As if it is that easy, isn't it?) No amount of clinical trials and other evidences would stop the doctors from doing so. The doctors have other reasons for their prescription as we had just discussed.

But in developing countries there seems to be the popular "load shedding" of the light at the end of the tunnel or the tunnel just seems to be too long. "Lets not be too pessimistic," I told myself and waited for the next patient of sore throat to come into my OPD.

I was attending to patients in the outskirt of Municipal Corporation of Delhi at Rangpuri village near the IGI airport. "Ah! Here she is", I thought and started explaining the uselessness of the anti-biotic and risk of bacterial resistance. The moment I ended, "Eether aane ka kya faida khaansi ka sarbat bhi nahei hain", she stormed out of the OPD.