Sore throat​​ / Tonsillitis

• Sore throat - acute (CKS)​, Tonsillitis (NHS Choices)

• FeverPAIN score (sore throat, cough/cold sx, muscle aches, hx of fever in last 24 hrs, onset of illness, cervical LNs, inflammed tonsils, pus on tonsils)

• CENTOR score to estimate the probability pharyngitis is streptococcal (GABHS). ≥3 of (1) tonsillar exudate (2) tender anterior cervical LN's (3) absence of cough (4) history of fever may benefit from antibiotics (Pen V for 10/7)

• AVOID ANTIBIOTICS or consider back-up/ delayed antibiotic prescription

• 82% of cases resolve in 7 days without antibiotics and pain is only reduced by 16 hours.

• Use FeverPAIN Score to assess. (*Centor criteria can also be used)

Criteria include:

• Fever in last 24h,

• Purulence,

• Attend rapidly under 3 days, severely

• Inflamed tonsils

• No cough or coryza).

Score 0-1: 13-18% streptococci isolation - use NO antibiotic strategy

Score 2-3: 34-40% streptococci isolation - consider no antibiotic or a back-up antibiotic prescription;

Score 4-5: 62-65% streptococci isolation. Use clinical judgement to assess severity on baseline symptoms (difficulty swallowing, runny nose, cough, headache, muscle ache, interference with normal activities) and use immediate antibiotic or 48 hour short delayed antibiotic prescription.

• Always share self-care advice & safety net.

• Complications are rare.

• If systemically unwell, refer to emergency department