The majority of acute sore throats (including pharyngitis and tonsillitis) are self‑limiting and often triggered by a viral infection of the upper respiratory tract. The symptoms can last for around 1 week, but most people will get better within this time without antibiotics, regardless of cause (bacteria or virus).
If you are concerned it may be strep throat (and therefore benefit from antibiotics) use the FeverPAIN scoring system. This reduces antibiotic prescribing by 30%!
- Fever (during previous 24 hours)
- Purulence (pus on tonsils)
- Attend rapidly (within 3 days after onset of symptoms)
- Severely Inflamed tonsils
- No cough or coryza (inflammation of mucus membranes in the nose)
Each of the FeverPAIN criteria score 1 point (maximum score of 5). Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause.
0 or 1 =13 to 18% likelihood of isolating streptococcus.
2 or 3 = 34 to 40% likelihood of isolating streptococcus.
4 or 5 =62 to 65% likelihood of isolating streptococcus. Treat these with penicillin (unless allergic) for a 5 to 7 day course ONLY (new evidence). Consider giving the same dosage twice a day rather than 4 times a day to improve compliance.
There is new guidance from the UK’s Faculty of Sexual and Reproductive Health with regards to taking the COCP. Please note this is accepted practice but is ‘off licence’ meaning the drug has not been formally approved for use in this way.
Most errors in taking the cocp occur in the pill free week. This pill free week is not necessary and should be shortened to 4 days.
Patients can now
- Run 2 or 3 packets together. This will give them regularity and regular menses. Only a 4 day break is needed.
- Continue running packets together until they get spotting. Then stop for 4 days.
- Continue running packets together whether there is spotting or not (like the POP).
Consider discussing this with your patients. It gives them more control and flexibility with their menses and reduces risk of pregnancy.