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2264 pages added, reviewed or updated during the last month (last updated: 21/4/2021)


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sore throat

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Sore throat is the symptom the patient presents. Some doctors feel uncomfortable that without antibiotics a few patients may risk the complications.

A review concluded that (1):

  • antibiotics are unnecessary for most patients with sore throat as it is a self-limiting condition, which resolves by one week in 85% of people, whether it is due to streptococcal infection or not
  • serious complications are rare
  • the Centor criteria may be useful to predict patients who are at higher risk of Group A beta-haemolytic streptococcus (GABHS) and complications, who may benefit from antibiotics
      • tonsillar exudate
      • tender anterior cervical lymph nodes
      • absence of cough
      • history of fever
    • in patients with tonsillitis who are unwell, and have three out of four of these criteria, the risk of quinsy is 1:60 compared with 1:400 in those who are not unwell
  • if antibiotics are clinically indicated, phenoxymethylpenicillin is an appropriate first choice (adult dose: 500mg two to four times a day for 10 days)
  • patients given antibiotics are more likely to reattend if they have another similar infection
  • a delayed prescription, for use after three days if symptoms are not starting to resolve or are getting significantly worse, may be more appropriate for some patients
  • offer advice and reassurance, and recommend analgesics for symptom relief in all patients

As most patients with a sore throat do not see a doctor it is worth asking why they came.

Reference:

  1. MeReC Bulletin 2006;17(3):12-14.
  2. BMJ 1997; 9: 315(7104):350-2

Last reviewed 03/2020

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