Acute Sore Throat (Antimicrobial)

• CKS
• FeverPAIN
• See Specialist Pharmacy Service for advice on using solid oral dosage form antibiotics in children
• See TAM ENT guidance on management of sore throat including recurrent, persistent and severe (quinsy +/- airway obstruction)

Amoxicillin and other broad-spectrum penicillin should not be used for the blind treatment of sore throat. Maculopapular rashes occur commonly with ampicillin and amoxicillin but are not usually related to true penicillin allergy. They almost always occur in people with infectious mononucleosis.

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

Scottish Antimicrobial Prescribing Group: resources for the management of children with respiratory tract infections.  Includes advice on delayed prescriptions in children and parent/carer safety netting information.

Use FeverPAIN Score: Fever in last 24h, purulence, attend rapidly under 3d, severely inflamed tonsils, no cough or coryza. 

Score 0 to 1: 13 to 18% streptococci, use NO antibiotic strategy;
2 to 3: 34 to 40% streptococci, use 3 day back-up antibiotic;
>4: 62 to 65% streptococci, use immediate antibiotic if severe, or 48hr short backup prescription.

Always share self-care advice & safety net.
Antibiotics to prevent Quinsy NNT >4000.
Antibiotics to prevent Otitis media NNT 200.

For further information on children see Empiric Antibiotic Therapy poster.

For glossary of terms see Glossary.