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Sore throat antibiotics and rheumatic fever

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Use of antibiotics in sore throat and risk of rheumatic fever:

  • Rheumatic fever was reported only in randomised controlled trials published before 1961, and the authors noted that the incidence has continued to decline in Western societies since then (1)
    • results from these early studies found that antibiotics reduced acute rheumatic fever by more than two-thirds compared with placebo (low-quality evidence)
      • sixteen studies (n=10,101) reported on rheumatic fever within 2 months, finding a significantly higher incidence in people treated with placebo (1.7%) compared with antibiotics (0.7%, risk ratio 0.27, 95% CI 0.12 to 0.60, p=0.0014)

  • a systematic review noted that (2):
    • antibiotics reduced acute rheumatic fever within 2 months when compared to the control group (Peto OR 0.36, 95% CI 0.26 to 0.50; 18 studies, 12,249 participants; moderate‐certainty evidence)


  1. NICE (January 2018). Sore throat (acute): antimicrobial prescribing
  2. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database of Systematic Reviews 2021, Issue 12. Art. No.: CD000023. DOI: 10.1002/14651858.CD000023.pub5. Accessed 21 May 2024.

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