Patients often come to the doctor with a sore throat wondering whether there is any treatment that will shorten the course of disease. It is worth examining the major causes of sore throats to determine what should be done.

The best known germ that can cause sore throats and tonsillitis is the Streptococcus. In fact only 10% of adults and less than 30% of children with sore throats have a Streptococcal infection. The majority of the rest are caused by viruses. Your doctor cannot tell whether a sore throat is caused by a Streptococcus or by a virus just by looking at the back of the mouth. It is possible to grow Streptococci from throat swabs. The results often come back after the sore throat has settled-not particularly useful. Additionally, some people are carriers of the Streptococcal germ and yet it does not cause symptoms. It is possible to grow these germs even if the sore throat is actually caused by a virus.

How about treatment?

We have no effective treatment for the viruses that cause most sore throats. Viruses differ from bacteria by using our own body's cells to multiply and cause infection. We cannot poison them with antibiotics-anything that stops the virus reproducing is likely to damage normal human tissue as well. We have to rely on our own immune system to mop up the infection. Usually it does a good, efficient job. However, there are thousands of different viruses. Each infection requires the immune system to start from fresh; to get up to speed usually takes 2-4 days. During this time you have the flu-like symptoms and sore throat. These are largely due to your immune system's normal response to infection and are a sign that you are fighting the germs.

Should we treat sore throats with antibiotics?

If the sore throat is a caused by a virus (most are) then clearly not. What if it caused by a Streptococcus bacteria? This is contentious. Firstly, it is difficult to establish that the Streptococcus is responsible for the sore throat-it will be so only in the minority of infections and may be present as an innocent bystander. Secondly, we need to know whether treatment really makes a difference. On average, treating a Streptococcal sore throat will reduce the duration of symptoms by 12-24 hours only. In other words, it makes little difference to short term symptom control. The published evidence suggests that treatment does not reduce the subsequent development of rheumatic fever after a Strep sore throat, and complications such as quinsy are rare so that treating all sore throats with penicillin is more likely to cause side effects than benefit. Moreover, the streptococci causing sore throats are not killed by penicillin in approximately 1 in 6 infections, so penicillin treatment is no guarantee of cure.

In summary, most sore throats are caused by viruses, the vast majority will get better on their own and treatment with antibiotics is ineffective in most cases. At best it might reduce the duration of the sore throat by 24 hours. If you take paracetamol regularly for the fever and pain and sit the infection out; it should get better within a few days and there is little we can do to speed up your recovery. If you feel your problem is different from an ordinary sore throat, we are always willing to see you and advise appropriately. Do not, however, expect an automatic prescription!