Sore throat

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