Columns and Letters

Column: Doctor’s In

Dear Doc, I have a sore throat. My friend had one too and she went to her doctor, who said antibiotics won’t help. What do you think?
    –Concerned from Creignish

Dear Concerned,
    A sore throat is a common problem that we see in both adults and children.
What causes sore throat?
    There are a few causes of sore throats.
    Sore throats are most commonly caused by an infection of the throat. Most of these infections are caused by a virus. A small number are caused by bacteria.
    At other times, the throat gets sore because it is irritated (rather than infected). For example, heart burn may cause stomach juices to come back up the eating tube (esophagus) and irritate the throat.
    In rare cases, a sore throat can be caused by something dangerous that can threaten someone’s ability to breath. One example is an infection called epiglottitis, which causes dangerous swelling at the top of the breathing tube. Epiglottitis can be prevented in children by having them vaccinated.
How does a doctor find out what’s causing a sore throat?
    When you visit a doctor about a sore throat, they consider a few things to figure out the specific cause:
1.    How likely is this to be something dangerous to a person’s breathing?
2.    If it is not dangerous, is it caused by an infection?
3.    If it is not dangerous or caused by an infection, what is the most likely cause?
    A doctor determines this by looking at how sick you appear, asking about your symptoms, and doing a physical exam – specifically looking at your throat and neck.
    As we said earlier, dangerous cases are rare; doctors go through years of training to identify these rare cases. One thing we listen for is stridor, which is a high-pitched sound that’s made when someone breathes in.
    But since most cases are not because of something dangerous, a doctor usually spends most of the time looking at the throat to determine if there is an infection.
What is the best treatment for throat infections?
    Whenever a doctor considers giving someone a medicine, they always weight two opposite factors:
(1)    What are the treatments’ potential benefits for the patient’s specific problem?
(2)    What are the treatments’ potential harms for the patient?
    If the benefits are significantly more than the potential harms, the doctor usually thinks about prescribing the medicine.
    Antibiotics are medicines that can help the body fight off infections caused by bacteria. They do not help fight viruses. Since most throat infections are caused by viruses, antibiotics usually do not help with throat infections.
But what if a throat infection is caused by a bacteria?
    First, let’s look at the potential harms of taking an antibiotic for a sore throat:
– They can make someone more resistant to antibiotics in the future, potentially making antibiotics less effective for future infections;
– They increase the chance of fungal infections in women;
– They can cause rashes;
– They can cause nausea, vomiting, abdominal pain, and diarrhea;
– They can rarely cause dangerous allergic reactions.
    Now, what are the main benefits of taking an antibiotic for a bacterial throat infection:
– They reduce how long you have a sore throat by 16 hours;
– They reduce your risk of rheumatic fever (a very rare problem in most of Canada).
    Let’s consider two more useful facts:
– Over the counter pain medicines like acetaminophen (Tylenol) and ibuprofen (Advil) are usually effective improving a sore throat (much sooner than antibiotics);
– If you don’t get antibiotics for a throat infection, you still have 90 per cent chance of being better within one week
    So given all this, there is still not a convincing reason to give antibiotics instead of simple (and very useful) pain medicines for infections caused by bacteria in most cases.
    So here is the bottom line:
– Sore throats have many causes and are commonly due to an infection;
– In rare cases, sore throats may be caused by something dangerous;
– Most throat infections are caused by viruses;
– Antibiotics do not help kill viruses;
– A small minority of throat infections are caused by bacteria;
– Although antibiotics can help with bacterial throat infections, they have many side effects, and over the counter pain medications are usually just as effective at treating the infection.
    Finally, I hope I was able to better answer your question! If you have any questions, please talk to your doctor.
    I encourage anyone with more questions to visit your family doctor.  There is also more information at:
    Smile!  Until next time be well!
    Dr. Pouria Rezapour is a first year family medicine resident from the Sydney Family Medicine Program.

Disclaimer:  The advice in this column is not intended to replace the advice of your physician.  Dr. Chiasson and The Oran are not responsible for any advice contained within the column.  You should not rely on this advice to determine a diagnosis or course of treatment.  “The Doctor Is In” welcomes all your letters, but regrets cannot answer all of them.  Only selected letters will be answered.  Please forward your health questions to:  The Doctor Is In, c/o The Oran, P.O. Box 100, Inverness, N.S., B0E 1N0 or email This email address is being protected from spambots. You need JavaScript enabled to view it..





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