Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #137 

August 2006

Treatment of Sore Throats: Antibiotic 

Prescriptions and Throat Cultures for 

Children under 18 Years of Age, 2002–

2004 (Average Annual) 

Steven R. Machlin, MS and Kelly Carper, MEd

Introduction 

Upper respiratory infections are common in children, and inappropriate treatment of these infections with an antibiotic is a public health 

concern. In particular, inappropriate use can have a negative impact 

on the effectiveness of antibiotics and increase the risk of infection 

with a drug-resistant pathogen.* 

The Michigan Quality Improvement Consortium recommends the 

following treatment of acute pharyngitis in children:†

 High risk children (those with past history or household exposure of

rheumatic fever) and those whose symptoms indicate a high 

probability of streptococcus pharyngitis should start antibiotics 

immediately, but if a throat culture is obtained and the result is

negative the antibiotics should be stopped. 

 Antibiotics should not be prescribed for children whose symptoms

indicate a low probability of streptococcus infection. 

 A throat culture (or rapid screen test) should be obtained for 

children with an intermediate probability of streptococcus and, if the 

result is positive, antibiotics should be prescribed.

This Statistical Brief uses data from the Household Component of the 

Medical Expenditure Panel Survey (MEPS-HC) to examine the 

percentages of children under 18 years of age for whom, within the 

past 12 months, 1) contact was made with a doctor or other health 

professional primarily regarding a serious sore throat, 2) an antibiotic 

was prescribed for those who contacted a health professional, and 3) a throat swab was admin-istered

before prescribing an antibiotic. Variations in these three measures are examined by selected

demographic characteristics and insurance status. Average annual estimates are shown for 2002–2004, 

and only differences that are statistically significant at the 0.05 level or better are cited in the text. 

Highlights 

 On average during 2002–

2004, contact was made with

a health professional regarding a primary sore throat 

condition within a 12-month 

period for 14.0 percent of 

children under 18 years of 

age. Of these children, over 

two-thirds (69.7 percent) were

prescribed antibiotics to treat

their sore throat. 

 Approximately one of every 

five children who were prescribed an antibiotic did not 

receive a throat swab before 

receiving the prescription. 

 Among children who had 

contact with a health professional for a sore throat, 

those age 13–17 were less 

likely to have an antibiotic 

prescribed than younger 

children.

 Children in metropolitan 

statistical areas with sore 

throats were less likely to 

be prescribed an antibiotic 

than children in other areas 

but were more likely to have 

a throat swab before a 

prescription.

* National Committee for Quality Assurance (NCQA): The State of Health Care Quality 2004; HEDIS Measures; Appropriate Testing 

for Children with Pharyngitis. http://www.ncqa.org/communications/sohc2004/appropriate_testing_pharyngitis.htm 

† Michigan Quality Improvement Consortium. Acute pharyngitis in children. Southfield (MI): Michigan Quality Improvement Consortium; 

2004 Apr. 1 page. NGC: 004557. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=8170&nbr=&string=#s23
Findings 

On average during 2002–2004, contact was made with a health professional regarding a primary sore 

throat condition within a 12-month period for 14.0 percent of children under 18 years of age (figure 1). 

Of these children, over two-thirds (69.7 percent) were prescribed antibiotics to treat their sore throat.

Approximately one of every five children (22.0 percent) who were prescribed an antibiotic did not receive

a throat swab before receiving the prescription. 

Age 

The likelihood of contact with a health professional for a serious sore throat varied by age, ranging from 

10.2 percent for children under age 5 to 16.5 percent for children 5–12 years of age (figure 2). Teenage 

children 13–17 years of age were less likely to have an antibiotic prescribed for a sore throat than 

younger children (65.3 percent versus 71.1–72.4 percent for the younger age groups). Children 5–12 

years of age who were prescribed an antibiotic were more likely to have a throat swab before the 

prescription (81.7 percent) than younger (70.1 percent) or older (76.5 percent) children. 

Race/ethnicity 

White non-Hispanic children were most likely (16.6 percent), and black non-Hispanic children were least 

likely (7.9 percent) to have contact with a health professional regarding a serious sore throat (figure 3). 

While there was no significant variation by race/ethnicity in the likelihood of being prescribed an antibiotic, 

white non-Hispanic children were significantly more likely to have had a throat swab before prescription 

than Hispanic children (80.5 versus 72.1 percent). Differences between white children and the other two 

race/ethnicity groups were not statistically significant. 

Insurance status 

Children with private insurance were more likely to have contact with a health professional for a serious 

sore throat (15.3 percent) than those with public only insurance (12.2 percent) or uninsured children (10.4 

percent) (figure 4). Uninsured children were less likely to have an antibiotic prescribed for a sore throat 

(64.2 percent) than children with public only insurance (72.9 percent). Children with private insurance 

were more likely to have a throat swab prior to an antibiotic prescription (80.8 percent) than children 

covered by public only insurance (70.9 percent). 

Region 

Children in the West were less likely than children in other regions to have contact with a health 

professional regarding a serious sore throat (11.1 percent versus 13.6–17.4 percent) (figure 5). Children 

in the South were most likely (74.7 percent) to have an antibiotic prescribed for treatment of a sore throat, 

and children in the Northeast were most likely to have a throat swab before prescription (85.4 percent). 

Metropolitan versus nonmetropolitan area 

The likelihood of contact with a health professional for a serious sore throat was not significantly different 

for children living in metropolitan statistical areas (MSA) and those living in other areas. Children in MSAs 

with sore throats were less likely to be prescribed an antibiotic (67.8 percent) than children in non-MSA 

areas (77.6 percent) but were more likely to have a throat swab before a prescription (81.1 percent) than 

children in non-MSA areas (66.5 percent) (figure 6). 

Data Source 

The estimates in this Statistical Brief are based on data from the MEPS 2002 Full Year Consolidated Data 

File (HC-070), the MEPS 2003 Full Year Consolidated Data File (HC-079), and the MEPS 2004 Full Year 

Population Characteristics Data File (HC-082). 

Definitions 

Sore throat survey questions 

Beginning in 2000, a series of questions were asked in the MEPS Quality Priority Conditions Supplement 

about the prevalence and treatment of sore throats for children under 18 years of age. The estimates in 

this brief are based on responses to the following questions from this supplement: 
Let’s talk about the last time (PERSON) had a sore throat that was serious enough to cause you to 

contact a doctor or other health professional. 

– Did this happen during the past 12 months? 

– Was that primarily because (PERSON) had a sore throat or was it primarily for other symptoms? 

– Did a doctor or other health professional prescribe an antibiotic for (PERSON)? 

– Did a doctor or other health professional give (PERSON) a throat swab before giving (PERSON) the 

antibiotic prescription? 

The questionnaire supplement containing these questions is available at 

http://www.meps.ahrq.gov/Data_Pub/Questionnaires/questhc5/YR03P7R5/PC-p7r5.PDF 

Racial and ethnic classifications 

Classification by race and ethnicity is based on information reported for each family member. 

Respondents were asked if each family member was Hispanic or Latino. Respondents were also asked 

which race or races best describes each family member. Race categories include white, black/African 

American, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and other. 

Based on these questions, sample persons were classified into the following four race/ethnicity 

categories: Hispanic or Latino, white non-Hispanic or Latino single race, black non-Hispanic or Latino 

single race, and other single race or multiple races non-Hispanic or Latino. 

Health insurance status 

Children were classified in the following three insurance categories, based on household responses to 

health insurance status questions: 

– Any private health insurance: Individuals who, at any time during the year, had insurance that provided 

coverage for hospital and physician care (other than Medicare, Medicaid, or other public 

hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE 

(Armed Forces–related coverage) was also included as private health insurance. Insurance that 

provides coverage for a single service only, such as dental or vision coverage, was not included. 

– Public only coverage: Individuals were considered to have public only coverage if they met both of the 

following criteria: 1) they were not covered by private insurance at any time during the year, 2) they 

were covered by one of the following public programs at any point during the year: Medicare, Medicaid, 

or other public hospital/physician coverage. 

– Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, 

Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the entire 

year or period of eligibility for the survey. 

Region 

– Northeast: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, 

New Jersey, and Pennsylvania 

– Midwest: Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South 

Dakota, Nebraska, and Kansas 

– South: Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South 

Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, 

Oklahoma, and Texas 

– West: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, 

California, Alaska, and Hawaii 

Metropolitan statistical area (MSA) 

Areas designated by the U.S. Office of Management and Budget that are composed of a large population 

nucleus combined with adjacent communities that have a high degree of economic and social integration 

with the nucleus. An MSA has one or more central counties containing the area’s main population 

concentration. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is 
cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care, 

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Machlin, S. R. and Carper, K. Treatment of Sore Throats: Antibiotic Prescriptions and Throat Cultures for 

Children under 18 Years of Age, 2002–2004 (Average Annual). Statistical Brief #137. August 2006. 

Agency for Healthcare Research and Quality, Rockville, Md. http://www.meps.ahrq.gov/papers/st137/ 

stat137 

∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
* Among those who contacted health professional

**Among those prescribed antibiotic

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

2002–2004

Figure 1. Treatment of sore throats for children under 18:

Selected measures, 2002–2004 (average annual)

14.0

69.7

78.0

0

20

40

60

80

100

Contacted health

professional for sore throat

Antibiotic prescribed* Throat swab**

Percent

* Among those who contacted health professional

**Among those prescribed antibiotic

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

2002–2004

Figure 2. Treatment of sore throats for children under 18:

Selected measures by age, 2002–2004 (average annual)

81.7

65.3

76.5

72.4 70.1

10.2

16.5

71.1

13.7

0

20

40

60

80

100

Contacted health professional 

for sore throat

Antibiotic prescribed* Throat swab**

0-4 years 5-12 years 13-17 years

Percent
* Among those who contacted health professional

**Among those prescribed antibiotic

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

2002–2004

Figure 3. Treatment of sore throats for children under 18:

Selected measures by race/ethnicity, 2002–2004 (average annual)

72.3 68.6 70.7 72.1

80.5

69.9

16.6

7.9

68.3

10.5

69.8

12.4

0

20

40

60

80

100

Contacted health professional 

for sore throat

Antibiotic prescribed* Throat swab**

White non-Hispanic or Latino single race

Black non-Hispanic or Latino single race

Other races/multiple race non-Hispanic or Latino

Hispanic or Latino

Percent

* Among those who contacted health professional

**Among those prescribed antibiotic

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

2002–2004

Figure 4. Treatment of sore throats for children under 18:

Selected measures by insurance status, 2002–2004 (average annual)

70.9

64.2

75.4 80.8

69.0

15.3 12.2

72.9

10.4

0

20

40

60

80

100

Contacted health professional

for sore throat

Antibiotic prescribed* Throat swab**

Private Public only Uninsured

Percent
* Among those who contacted health professional

**Among those prescribed antibiotic

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

2002–2004

Figure 5. Treatment of sore throats for children under 18:

Selected measures by region, 2002–2004 (average annual)

76.4 74.7 77.5 73.3

85.4

63.3

17.4 15.3

69.4

13.6

68.0

11.1

0

20

40

60

80

100

Contacted health professional 

for sore throat

Antibiotic prescribed* Throat swab**

Northeast Midwest South West

Percent

* Among those who contacted health professional

**Among those prescribed antibiotic

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

2002–2004

Figure 6. Treatment of sore throats for children under 18: Selected

measures by metropolitan area status, 2002–2004 (average annual)

66.5

81.1

67.8

13.8 15.3

77.6

0

20

40

60

80

100

Contacted health professional

for sore throat

Antibiotic prescribed* Throat swab**

Metropolitan statistical area

Nonmetropolitan area

Percent