Are you sure antibiotics are needed? Follow these rules

Antibiotics should not be prescribed for patients with conditions that are clearly viral in nature, says Katherine L. Heilpern, MD, FACEP, interim residency director and assistant professor in the department of emergency medicine at Emory University School of Medicine in Atlanta.

"Patients with upper respiratory tract infections, such as bronchitis and many episodes of pharyngitis, do not need antibiotics," she stresses.

When sore throat is associated with laryngitis or nasal congestion, antibiotics are usually not needed, stresses Heilpern. "Cough is not usually associated with classic strep throat. If you can do a rapid strep screen in a patient with isolated sore throat, or if the patient has isolated sore throat, fever, and tender anterior cervical lymph nodes, they should probably get treated."

Clearly, there are other bacterial pathogens that can cause pharyngitis, but you need to determine if strep is responsible, Heilpern cautions. "We still have to remain vigilant for the consequences of inadequate treatment of strep pharyngitis/rheumatic fever. This is why we try to make the diagnosis of Group A streptococcal pharyngitis and initiate appropriate antibiotic therapy."