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.