Acute Sore Throat
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.