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Sore throat - acute - Management
When should I prescribe an antibiotic for sore throat?
- Do not routinely prescribe antibiotics for acute sore throat.
- Antibiotics should not be prescribed to:
- Secure symptomatic relief.
- Prevent suppurative complications.
- Treat recurrent non-streptococcal sore throat.
- Prevent the development of rheumatic fever and acute glomerulonephritis.
- Consider a delayed antibiotic prescribing strategy for people with sore throat where it is felt safe not to prescribe antibiotics immediately.
- Reassure the person that antibiotics are not needed immediately as they will make little difference to symptoms, and may have adverse effects.
- Advise the person to use the delayed prescription if symptoms do not settle or get significantly worse.
- Advise the person about the need for review if symptoms get significantly worse despite using the delayed prescription.
- Consider a 2 or 3-day delayed prescription or immediate antibiotics for people with a sore throat and a Centor score of 3 or 4 (presence of tonsillar exudate, tender anterior cervical lymphadenopathy or lymphadenitis, history of fever, and absence of cough).
- Prescribe an antibiotic for:
- Those with features of marked systemic upset.
- Those at increase risk of serious complications.
- Those with valvular heart disease.
- Have a low threshold for prescribing an antibiotic in people:
- With an increased risk of severe infection (e.g. diabetes or immunocompromised).
- Who are at risk of immunosuppression (e.g. on disease-modifying anti-rheumatic drugs [DMARDs], carbimazole).
- With a history of rheumatic fever.
- People with peritonsillar abscess or peritonsillar cellulitis will receive antibiotics in secondary care: admit immediately.
- An antibiotic may be useful in:
- Preventing cross-infections with group A beta-haemolytic streptococcus (GABHS) in closed institutions such as barracks or boarding schools. However, it should not be used routinely to prevent cross-infection in the general community.
- Treating recurrent sore throat associated with GABHS.
In depth
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