Consider prescribing antibiotics for a patient with an acute sore throat if they have a FeverPAIN score of 4 or 5, or a Centor score of 3 or 4, or if group A streptococcus (GAS) infection is confirmed by rapid antigen testing. In these cases, an immediate antibiotic prescription or a back-up antibiotic prescription may be appropriate, taking into account the low likelihood of complications if antibiotics are withheld and the possible adverse effects such as diarrhoea and nausea.
For patients with a FeverPAIN score of 2 or 3, consider no antibiotic prescription or a back-up prescription, advising that antibiotics are not needed immediately and should only be used if symptoms do not improve within 3 to 5 days or worsen significantly.
Do not offer antibiotics if the FeverPAIN score is 0 or 1, or the Centor score is 0, 1, or 2. Instead, advise patients that antibiotics are not needed and to seek medical help if symptoms worsen rapidly, do not improve after 1 week, or if they become systemically very unwell.
Prescribe phenoxymethylpenicillin as the first-line antibiotic; for patients with penicillin allergy, prescribe clarithromycin, and erythromycin if the patient is pregnant and allergic to penicillin.
Offer immediate antibiotic treatment to patients who are systemically very unwell, have signs of more serious illness, or are at high risk of complications.
Advise all patients that symptoms may last around 1 week, and provide safety-netting advice on when to seek further medical help.
Key References
- CKS - Sore throat - acute
- CKS - Sinusitis
- NG15 - Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use
- NG237 - Suspected acute respiratory infection in over 16s: assessment at first presentation and initial management
- NG63 - Antimicrobial stewardship: changing risk-related behaviours in the general population