Prescribing antibiotics for common sore throats may have only a minimal impact on preventing serious streptococcal infections, according to new research from the University of Gothenburg. The findings challenge a widely debated rationale for antibiotic use and highlight the importance of recognizing early signs of severe illness instead.
The study focused on Group A Streptococcus (GAS), a bacterium responsible for many throat infections. In some cases, the bacteria can cause invasive Group A streptococcal disease (iGAS), a rare but potentially life-threatening condition that occurs when the infection spreads to areas such as the bloodstream or lungs. Health authorities in several countries have reported a rise in iGAS cases in recent years.
Researchers examined whether treating uncomplicated sore throats with antibiotics could reduce the occurrence of severe streptococcal infections across the population. Their findings, published in the International Journal of Infectious Diseases, suggest that the preventive benefit is far smaller than previously assumed.
Using scientific evidence combined with nationwide epidemiological data from Sweden in 2024, the investigators modeled several treatment strategies. Even under a highly aggressive approach—where every patient seeking care for a sore throat is tested and treated if they carry GAS bacteria the reduction in iGAS cases would be limited to a maximum of 6.7% among children and 2.8% among adults.
When applying current Swedish clinical guidelines, which recommend testing only patients meeting specific symptom-based criteria, the projected reduction falls even further, preventing at most 1.6% of cases in children and 1.2% in adults.
Lead researcher Ronny Gunnarsson, Family Physician and Professor Emeritus at the University of Gothenburg, said the findings indicate that the role of antibiotics in preventing severe streptococcal disease has been overstated.
The researchers estimated that preventing a single iGAS case would require throat swab testing of tens of thousands of patients and, in some scenarios, the prescription of up to 110,000 antibiotic courses. Such an approach would place a substantial burden on primary healthcare services while increasing the risk of unnecessary antibiotic exposure and associated side effects.
The study also explains why antibiotic treatment has limited population-level impact. Many individuals with sore throats never seek medical attention, while those who do often visit healthcare providers several days after symptoms begin, typically after the period when they are most likely to spread the bacteria. Furthermore, a significant proportion of severe infections originate from asymptomatic carriers who show no symptoms and therefore would not be identified for treatment.
Based on these findings, the researchers caution against expanding testing and antibiotic prescribing practices for uncomplicated throat infections. Instead, they recommend that healthcare systems focus on the rapid identification of warning signs associated with serious invasive infections.
The authors also emphasize the potential value of future preventive measures, including the development of safe and effective vaccines against streptococcal bacteria, which may offer a more practical long-term solution to reducing severe disease.
