Sore Throat

Question 1

Which organism is the most common bacterial cause of sore throat?

Answer 1

Streptococcus pyogenes

Question 2

Are antibiotics required in the management of sore throat in primary care?

Answer 2

• 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

Question 3

Outline the Centor criteria.

Answer 3

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

Question 4

What is the clinical significance of a Centor score of 3/4 in tonsilitis?

Answer 4

The patient has a risk of quinsy of 1:60 compared to 1:400 in those not unwell

Question 5

Outline the NICE guidance in antimicrobial prescribing in acute sore throat.

Answer 5

Question 6

What is the first-line antibiotic choice? (Adults)

Answer 6

Phenoxymethylpenicillin 500 mg four times a day for 5-10 days / or 1000 mg twice a day for 5-10 days

Question 7

What are the alternative first choices of antibiotic in those with penicillin allergy? (Adults)

Answer 7

1. Clarithromycin 250 to 500 mg twice a day for 5 days
2. Erythromycin 250 to 500 mg four times a day for 5 days OR 500 to 1000 mg twice a day for 5 days

Question 8

Outline what is meant by a back-up prescription.

Answer 8

• a back-up (delayed) prescription is one that is given in a way to delay the use of a medicine (usually an antibiotic), and with advice to only use it if symptoms worsen or don’t improve within a specified time.
• FeverPAIN score 2-5; Centor score of 3/4.

Question 9

Outline the FeverPAIN criteria.

Answer 9

FeverPAIN criteria

Fever (during previous 24 hours)

Purulence (pus on tonsils)

Attend rapidly (within 3 days after onset of symptoms)

Severely Inflamed tonsils

No cough or coryza (inflammation of mucus membranes in the nose)

Question 10

A patient with a sore throat re-presents with a florid punctate rash on their arms and legs. What may this be suggestive of?

Answer 10

• Scarlet fever
• Notifiable disease
• Requires penicillin V
• Late complications include rheumatic fever and post-streptococcal glomerulonephritis

Question 11

Quinsy/peri-tonsilar abscesses can be complications of acute tonsilitis - how should this be managed?

Answer 11

• SAME DAY REFERRAL TO ENT
• May be an indication for tonsillectomy