Acute Sore Throat

Acute sore throat
CKS
FeverPAIN

Avoid antibiotics as 90% resolve in 7 days without, and pain only reduced by 16 hours.

Use FeverPAIN Score: Fever in last 24h, Purulence, Attend rapidly under 3d, severely Inflamed tonsils, No cough or coryza. 

Score 0-1: 13-18% streptococci, use NO antibiotic strategy;
2-3: 34-40% streptococci, Offer a delayed antibiotic prescription;
>4: 62-65% streptococci, use immediate antibiotic if severe, or offer delayed antibiotic prescription.

When giving a delayed antibiotic prescription, advise:

  • Antibiotic is not needed immediately
  • Use if symptoms rapidly deteriorate, significantly worsen, or do not improve within 3 to 5 days
  • Manage symptoms with self-care
  • Return if symptoms significantly worsen or don’t resolve after antibiotic is stopped



Always share self-care advice & safety net.
Antibiotics to prevent Quinsy NNT >4000.
Antibiotics to prevent Otitis media NNT 200.
10d penicillin lower relapse vs 7d in ​<18yrs.

Phenoxymethylpenicillin

500mg QDS or 1G BD (QDS when severe)

 child dose

10 days

Penicillin Allergy: Clarithromycin

250-500mg BD 

child dose

5 days