The findings suggest that there’s a great deal of misunderstanding around how to treat sore throats, leading to antibiotic overuse.

The study, conducted in May, surveyed 12,000 people from 12 countries aged 18 to 64 who had experienced respiratory symptoms that they had treated in the past six months.

A thousand people were surveyed in each country, covering Brazil, Germany, Italy, Mexico, Philippines, Poland, Romania, Saudi Arabia, South Africa, Spain, Thailand and the UK.

Over half of adults had taken antibiotics for a minor condition like a sore throat in the past six months.

This habit was especially prevalent in people under the age of 35, with 45 per cent of people in this age group claiming they didn’t know how else to treat a sore throat.

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Reaching out to antibiotics as a first resort was a behaviour largely driven by anxiety, the study found.

“This study highlights that there remains much to be done, in many countries, to improve education about the use of antibiotics and emphasise that antibiotics must be seen as a scarce and important resource only to be used for severe infections,” says Dr Martin Duerden, a medical adviser at Cardiff University in Wales, on behalf of GRIP.

“The message for sore throat is that most of these – around 90 per cent – get better without antibiotics.”

All too often, antibiotics commonly used to treat severe illnesses no longer work because people use them too much for minor ailments, causing certain germs to become resistant to them. This antimicrobial resistance – or AMR – is now a growing global concern.

“The simple fact is that we are rapidly running out of antibiotics to treat important, life-threatening infections that in the past could be cured,” Duerden says.

“Development of new antibiotics has not kept pace with the loss of standard antibiotics that now have been rendered ineffective, due to overuse and inappropriate use.”

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AMR is now one of the leading causes of death in nearly all countries. A recent analysis of the global burden of AMR found that in 2019, an estimated 4.95 million deaths were associated with AMR in bacterial infections, with 1.27 million deaths directly “attributable” or caused by no longer having effective antibiotics.

The rates were highest in sub-Saharan Africa, South Asia and Eastern Europe. Other studies have found that it’s a growing global problem, but especially rampant in China.

Younger people tend to misuse antibiotics because they don’t understand that most sore throats are caused by viruses, and only a small number are caused by bacteria – usually streptococcus, Duerden says. Both types of sore throat tend to heal with the body’s own immune system and within a week, he says.

Clinical examination – by looking at the throat – is generally poor at differentiating whether a sore throat is viral or bacterial. Instead, Duerden suggests a throat swab.

The procedure can be expensive, though, and it takes several days for a clinical assessment, says Dr Ming Wai-kit, an assistant professor in public health and epidemiology at City University of Hong Kong, who was not a part of the study.

“A lot has changed in the years that Hong Kong has battled with Covid. More people tend to approach their doctors and not self-medicate at this time, but there are still situations where misuse of antibiotics commonly occurs,” he says.

Although there are strong restrictions, some pharmacists may still sell antibiotics over the counter, without a prescription. More often, teenagers, who don’t understand the difference between viruses and bacteria, tend to misuse antibiotics the most.

“There is a need to educate teenagers and to create this awareness at schools,” Ming says. “They should know the effects of antibiotics on their systems – that there can be side effects as a result of overuse. Public awareness is the key to solving this, even as we tighten laws.”

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General measures used to treat colds can also apply to sore throats, Duerden says.

“Patients should be advised to rest and drink plenty, and eat cool or soft foods. Sucking ice cubes, ice lollies or sweets may be soothing,” he says.

“The main other interventions are simple painkillers such as paracetamol or ibuprofen, that can be purchased ‘over the counter’ [without prescription] in most countries.”

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The new study’s results are concerning, says Sabiha Essack, professor in pharmaceutical sciences at the University of KwaZulu-Natal in South Africa.

Essack is also an expert consultant on antimicrobial resistance to the World Health Organization and is GRIP’s South African research chair in antibiotic resistance.

“Under 35s – our leaders and workforce of the future – incorrectly believe that antibiotics work for all sore throats and colds, and may be unaware of the consequences of inappropriate antibiotic use on a personal and public health level,” Essack says.

GRIP is calling for awareness and education on appropriate antibiotic use and urges young people to ask questions to help the fight against antibiotic resistance.