Sore throat – when to use antibiotics

22nd February 2018 by Louise Hudman

Sore throat – when to use antibiotics

This is a new guideline from NICE which advises on when to use antibiotics in patients with tonsillitis or sore throat. If you already use a scoring system to help you decide when to prescribe it doesn’t change a lot. Take home points: use a scoring system (FeverPAIN or Centor) and prescribe penicillin 500mg QDS or 1g BD for 5 – 10d.

There is a fantastic 2 page, stick it on your wall guide from NICE which summarises it all nicely.

Useful background information on sore throats and antibiotics

  • About 20% of cases are bacterial and most of those are Group A beta-haemolytic strep (GABHS).
  • Complications are rare (eg NNT = 200 to prevent 1 case of otitis media).
  • Most people are better within a week, whether it is bacterial or viral.
  • Antibiotics on average shorten the illness by about 16 hrs over 7d.

FeverPAIN and Centor

Use one of these scoring tests to help you decide whether to prescribe antibiotics. At present there is no clear indication which is better in a GP population in the UK, so using either is OK. I’ll give a bit of information about each as it may help you decide which works better for you.

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