Acute Sore Throat (Antimicrobial)


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.

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.

Drug details

Phenoxymethylpenicillin 500mg four times daily or 1 gram twice daily (increase to four times daily when severe) - see BNFC for children dosing information.

5 days.

10 days for recurrent infection or high suspicion/confirmation of streptococcal throat infection

Penicillin Allergy

Clarithromycin 500mg twice daily - see BNFC for children dosing information.

5 days

Last reviewed: 02/09/2019

Next review date: 02/09/2022

Author(s): Antimicrobial Management Team.

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT151