Sore throats in general
Doctors should not prescribe ‘precious’ antibiotics for most people with sore throats and should recommend drugs like paracetamol. Many of these infections are caused by viruses rather than bacteria – and neither need nor respond to antibiotics. The body can often fight these infections by itself if a person is otherwise healthy.
NICE highlighted the following ways of managing symptoms:
- managing any associated fever with paracetamol
- managing pain using paracetamol or, if preferred and suitable, ibuprofen
- avoiding dehydration by drinking enough fluids
- being aware that it’s normal for a sore throat to last around a week before clearing up, regardless of whether the cause was bacterial or viral
A tool called the FeverPAIN score can be used to help doctors make decisions about who might benefit from antibiotics.
A person with a sore throat scores one point for each of the following criteria:
- fever (during previous 24 hours)
- purulence (pus on tonsils)
- they feel the need to attend a GP or other doctor rapidly (within 3 days after onset of symptoms)
- severely inflamed tonsils
- no cough or coryza (inflammation of mucus membranes in the nose)
People who score 0 or 1 aren’t likely to benefit from antibiotics at all.
For a score of 2 or 3, a doctor may choose between not prescribing and giving advice to come back if symptoms worsen, or giving a “back-up” prescription that should only be filled if symptoms don’t improve after a week.
People who score 4 or 5 are most likely to benefit from an immediate antibiotic prescription, but that doesn’t mean one will automatically be given – the doctor will take into account other factors, too.
People who are very unwell with symptoms of a more serious illness or condition, or who are at high risk of complications, are also likely to be given an immediate antibiotic, or in some cases may need hospital admission.
“Paradise” criteria for Tonsillectomy
- Seven or more throat infections in the preceding year, or
- five or more a year for each of the preceding two years, or
- three or more a year for each of the preceding three years
- Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial
Birgit K van Staaij, Emma H van den Akker, Maroeska M Rovers, Gerrit Jan
Hordijk, Arno W Hoes, Anne G M Schilder
- Commentary: Watchful waiting is useful for children with recurrent throat infections