Sore throat (acute): antimicrobial prescribing
When no antibiotic given, advise:
Self-care
FeverPAIN • antibiotic is not needed
score 0 or 1 • seeking medical help if symptoms
Do not offer an worsen rapidly or significantly, do • Consider paracetamol for
or pain or fever, or if preferred
antibiotic not start to improve after 1 week or
Use FeverPAIN Centor score and suitable, ibuprofen
the person becomes very unwell
or Centor score 0, 1 or 2 • Drink adequate fluids
for assessing • Some evidence that
With a back-up antibiotic prescription,
symptoms medicated lozenges can
advise: help reduce pain in adults
• antibiotic is not needed immediately • No evidence was found
Advise:
Consider no antibiotic • use prescription if no improvement for non-medicated
FeverPAIN lozenges, mouthwashes,
or a back-up antibiotic in 3 to 5 days, or symptoms worsen
• sore throat can score 2 or 3 prescription or local anaesthetic mouth
last around • seeking medical help if symptoms spray on its own
worsen rapidly or significantly or
1 week the person becomes very unwell
Evidence on
Acute sore throat
• manage antibiotics
symptoms with With an immediate antibiotic
FeverPAIN prescription, advise: • Antibiotics make little difference
self-care Consider an immediate
score 4 or 5 or • seeking medical help if symptoms to how long symptoms last
antibiotic or a back-up
Centor score antibiotic prescription worsen rapidly or significantly or or the number of people
whose symptoms improve
3 or 4 the person becomes very unwell
• Withholding antibiotics is unlikely
to lead to complications
• Possible adverse effects
include diarrhoea and nausea
Reassess at any time if symptoms worsen rapidly or significantly, taking account of:
• other possible diagnoses FeverPAIN score
• any symptoms or signs suggesting a more serious illness or condition
• previous antibiotic use, which may lead to resistant organisms
• Fever; purulence; attend within
If the person: 3 days or less; severely inflamed
tonsils; no cough or coryza
is systemically very
1 point for each
unwell, or Refer to hospital if:
has symptoms and signs Offer an immediate • severe systemic Centor score
of a more serious illness antibiotic prescription infection, or
or condition, or • severe complications • Tonsillar exudate; tender anterior
cervical lymphadenopathy
has high risk of or lymphadenitis; history of
complications fever (>38°C); no cough
1 point for each
Updated February 2023
Sore throat (acute): antimicrobial prescribing
Antibiotic 1 Dosage and course length for adults aged 18 and over
First choice
500 mg four times a day or 1000 mg twice a day for 5 to 10 days
Phenoxymethylpenicillin
Five days of phenoxymethylpenicillin may be enough for symptomatic cure,
but a 10-day course may increase the chance of microbiological cure
Alternative first choice for penicillin allergy or intolerance (for people who are not pregnant)
Clarithromycin 250 mg to 500 mg twice a day for 5 days
Alternative first choice for penicillin allergy in pregnancy
250 mg to 500 mg four times a day, or
500 mg to 1000 mg twice a day for 5 days
Erythromycin is preferred if a macrolide is needed in pregnancy, for
Erythromycin
example, if there is true penicillin allergy and the benefits of antibiotic
treatment outweigh the harms. See the Medicines and Healthcare products
Regulatory Agency (MHRA) Public Assessment Report on the safety of
macrolide antibiotics in pregnancy
1 Note: see the BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal
impairment, pregnancy and breast-feeding.
Sore throat (acute): antimicrobial prescribing
Antibiotic 1 Dosage and course length for children and young people under 18 2
First choice
1 to 11 months: 62.5 mg four times a day, or 125 mg twice a day for 5 to 10 days
1 to 5 years: 125 mg four times a day, or 250 mg twice a day for 5 to 10 days
6 to 11 years: 250 mg four times a day, or 500 mg twice a day for 5 to 10 days
Phenoxymethylpenicillin 12 to 17 years: 500 mg four times a day, or 1000 mg twice a day for 5 to 10 days
Five days of phenoxymethylpenicillin may be enough for symptomatic cure, but a 10-day course may
increase the chance of microbiological cure
Alternative first choice for penicillin allergy or intolerance (for people who are not pregnant)
1 month to 11 years: Under 8 kg: 7.5 mg/kg twice a day for 5 days
8 to 11 kg: 62.5 mg twice a day for 5 days
12 to 19 kg: 125 mg twice a day for 5 days
Clarithromycin
20 to 29 kg: 187.5 mg twice a day for 5 days
30 to 40 kg: 250 mg twice a day for 5 days
12 to 17 years: 250 mg to 500 mg twice a day for 5 days
Alternative first choice for penicillin allergy in pregnancy
8 to 17 years: 250 mg to 500 mg four times a day, or 500 mg to 1000 mg twice a day for 5 days
Erythromycin Erythromycin is preferred if a macrolide is needed in pregnancy, for example, if there is true penicillin allergy
and the benefits of antibiotic treatment outweigh the harms. See the Medicines and Healthcare products
Regulatory Agency (MHRA) Public Assessment Report on the safety of macrolide antibiotics in pregnancy
1 Note: see the BNF for children for appropriate use and dosing in specific populations, for example, hepatic impairment or renal impairment.
Note: the age bands given in the table apply to children of average size and, in practice, the prescriber will use the age bands in conjunction with other factors
2 such as the severity of the condition and the child’s size in relation to the average size of children of the same age.
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