sore throat

Question 1

what does sore throat encompass?

Answer 1

pharyngitis, tonsilitis, laryngitis

Question 2

what is recommended by CKS in pts with a sore throat?

Answer 2

do not routinely carry out throat swabs and rapid antigen tests

Question 3

how are pts with sore throat managed?

Answer 3

1. paracetamol / ibuprofen for pain relief
2. abx not routinely indicated
3. some evidence that a single dose of oral corticosteroid may reduce severity and duration of pain (but has not been incorporated into UK guidelines)

Question 4

what are the NICE indications for abx in pts with sore throat?

Answer 4

1. features of marked systemic upset 2˚ to acute sore throat
2. unilateral peritonsilitis
3. hx of rheumatic fever
4. increased risk from acute infection (e.g. child with DM / immunodeficiency)
5. pts w acute sore throat/acute pharyngitis/acute tonsilitis when ≥3 Centor criteria present

Question 5

what are the scoring systems available to try predict whether a sore throat is likely due to a bacterial infection, and therefore would benefit from abx?

Answer 5

1. Centor criteria
2. FeverPAIN score

Question 6

what is the Centor criteria?

Answer 6

score 1 pt for each (max 4):

• presence of tonsillar exudate
• tender anterior cervical lymphadenopathy / lymphadenitis
• hx of fever
• absence of cough

Question 7

what does a Centor score of 0, 1 or 2 mean?

Answer 7

3-17% likelihood of isolating Streptococci

Question 8

what does a Centor score of 3 or 4 mean?

Answer 8

32-56% likelihood of isolating Streptococci

Question 9

what is the FeverPAIN criteria?

Answer 9

score 1 pt for each (max 5):

• fever >38˚C
• (P)urulence (pharyngeal/tonsillar exudate)
• (A)ttend rapidly (≤3 days)
• severely (I)nflammed tonsils
• (N)o cough or coryza

Question 10

how do you interpret the FeverPAIN score?

Answer 10

Question 11

what abx do you give if it is indicated?

Answer 11

penicillin V

if penicillin allergic, give erythromycin

7-10 day course