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