Acute Sore Throat

Duration

depends on agent used

First Line

Therapy

Phenoxymethylpenicillin PO  500 mg every 6 hours; increased if necessary up to 1 g every 6 hours - for 5 -10 days

Penicillin Allergy

Therapy

Clarithromycin PO 250 - 500 mg twice daily for 5 days

Clarithromycin should not be prescribed concurrently with ciclosporin, sirolimus and tacrolimus.

Notes

  • If  trismus, stridor or breathing difficulties are present, arrange for urgent hospital transfer and do not examine the throat as this can cause acute airway obstruction in epiglottitis.
  • Pharyngitis is usually a viral infection (50-80%). Streptococcal infection is most likely in children from 5 to 15 years and less likely in younger or older patients. In >90% of cases, resolution of symptoms occurs within 7 days without any antibiotic treatment. 
  • Group A Streptococci are universally penicillin susceptible.
  • Use the FeverPAIN Score to assess need for antimicrobial prescription (1 point each):
    • Fever in last 24h
    • Purulent tonsillar exudate
    • Attending after duration of symptoms <3 days
    • Severely Inflamed tonsils
    • No cough or coryza

FeverPAIN score

Likelihood of S. pyogenes

Prescription strategy

0-1

13-18%

antimicrobial not advised

2-3

34-40%

delayed prescription (3 days)

>4

62-65%

Immediate treatment  if severe, or 48hr delayed prescription
  • Do not take throat swabs routinely, even if the sore throat persists.  Throat swabs have poor specificity and sensitivity.