The Effect of Absent or Deferred Antibiotic Treatment on Pharyngotonsillitis Complications in Primary Care Before, During, and After the COVID-19 pandemic

This study explored trends in antibiotic use and the risk of complications for pharyngotonsillitis in Swedish primary care before, during and after the pandemic. Using register-based data from 295,972 cases (2018–2023) of patients aged 12 + in the Stockholm and Västra Götaland regions with a 180-day washout period, logistic regression models assessed 30-day complication risks for patients who received antibiotics versus those who did not. Antibiotic prescriptions decreased during the pandemic, followed by a partial rebound, with penicillin remaining the preferred antibiotic. Complications, particularly peritonsillar abscess, were more frequent in patients receiving antibiotics (1.75%) than in untreated individuals (0.43%). Patients prescribed penicillin had fewer complications (1.62%) compared to other antibiotics (2.87%). Adjusted analyses showed the risk for complications was lower for untreated patients (aOR 0.24, 95% CI 0.22–0.26). The pandemic significantly impacted prescribing patterns, supporting penicillin’s continued use as a first-line therapy supported by its association with lower complication risks.