Acute Sore Throat
Antimicrobial prescribing: NHS Forth Valley
Avoid antibiotics as 82% 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
Score 2-3: 34-40% streptococci, consider no antibiotic or give 3-day back-up prescription (to be used if no improvement at 3-5 days)
Score >4: 62-65% streptococci, use immediate antibiotic if severe, or 2-day back-up prescription (to be used if no improvement)
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 5d in <18yrs.
Drug details
Phenoxymethylpenicillin
500mg QDS or 1G BD (QDS when severe)
Child
1 to 11 months: 62.5mg QDS or 125mg BD
1 to 5 years: 125mg QDS or 250mg BD
6 to 11 years: 250mg QDS or 500mg BD
12 to 17 years: 500mg QDS or 1000mg BD
5 days (extended to 10 days in severe cases)
(Five days of phenoxymethylpenicillin may be enough for symptomatic cure, but a 10-day course may
increase the chance of microbiological cure)
Penicillin Allergy:Clarithromycin
250-500mg BD
Child
1 month to 11 years:
Under 8 kg - 7.5mg/kg BD
8 to 11 kg - 62.5mg BD
12 to 19 kg: 125mg BD
20 to 29 kg - 187.5mg BD
30 to 40 kg - 250mg BD
12 to 17 years: 250mg to 500mg BD
5 days
Penicillin Allergy in Pregnancy: Erythromycin
500mg QDS
5 days