Management of acute sore throat in primary care

• establish the reason for the consultation
  
  
• establish the duration of the illness - infections usually resolve within five days
  
  
• review other risk factors
  
  
• consider aetiology of sore throat - most frequently look for features suggesting:
  • an infective cause
  • an indication for antibiotics
    
    
• analgesia (1):
  • paracetamol and NSAIDs have good evidence of action in adults and are safe in the majority of cases
  • paracetamol and NSAIDs are safe, in most cases, in paediatric patients, but codeine should be used with caution
  • anaesthetic mouth washes have some evidence of benefit and should be considered for symptomatic relief
• soluble paracetamol held in the mouth and then swallowed eases the discomfort (2)

Summary of Public Health England (PHE) guidance regarding antibiotic treatment of sore throat (3)

• in general, avoid antibiotics as 90% resolve in 7 days without, and pain only reduced by 16 hours
• if Centor score 3 or 4: (Lymphadenopathy; No Cough; Fever; Tonsillar Exudate) - consider 2 or 3-day delayed or immediate antibiotics or rapid antigen test
• antibiotics to prevent Quinsy number needed to treat (NNT) >4000
• antibiotics to prevent Otitis media NNT 200
• 10d penicillin lower relapse vs 7d in RCT in <18yrs

NICE suggest (4):

• base use of antibiotics on the FEVERpain or Centor Criteria scores

Open Image in Modal

Antibiotics appropriate for management of sore throat (2):

Open Image in Modal

Reference:

1. Bird JH et al. Controversies in the management of acute tonsillitis: an evidence-based review.Clin Otalaryngol. 2014 Dec;39(6):368-74
2. Prescriber (2000);11 (23): 83-87.
3. Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation
4. NICE (January 2018). Sore throat (acute): antimicrobial prescribing.