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Acute Sore Throat

(For adults and children aged 5 years and over)
Exclude: pregnant individuals under 16 years

Consider the risk of deterioration, red flags or serious illness:
  • Suspected Epiglottitis (4Ds: dysphagia, dysphonia, drooling, distress) - Do not examine throat
  • Severe complications suspected (e.g. clinical dehydration, signs of pharyngeal abscess)
  • Stridor (noisy or high pitched sound with breathing)
Gateway Point
Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999.
Does the patient have ANY of the following criteria?
  • Signs/symptoms indicating possible scarlet fever, quinsy or glandular fever
  • Signs/symptoms of suspected head/neck cancer (e.g. persistent mouth ulcers or unexplained lump in neck)
  • Is the patient immunosuppressed?
Onward referral
• General practice
• Other provider

Use FeverPAIN Score to assess (1 point for each):

Current Score: 0
FeverPAIN Score 0 or 1
Self-care and pain relief
• Antibiotic is not needed
• Offer over the counter treatment for symptomatic relief
• Drink adequate fluids
Ask patient to return to Community Pharmacy after 1 week if no improvement for pharmacist reassessment.
FeverPAIN Score 2 or 3
Gateway Point
Self-care and pain relief
• Antibiotics make little difference to how long symptoms last
• Withholding antibiotics is unlikely to lead to complications
Ask patient to return to Community Pharmacy if no improvement within 3-5 days.
RETURNING PATIENT
Gateway Point
After pharmacist reassessment (including red flags) patient can be offered antibiotics if appropriate based on clinician global impression.
FeverPAIN Score 4 or 5
Gateway Point
Shared decision making approach using TARGET RTI resources and clinician global impression.
Consider pain relief and self care as first line treatment.
Consider offering an immediate antibiotic.
Offer phenoxymethylpenicillin (if no allergy) for 5 days plus self care.
Reported penicillin allergy?
Offer clarithromycin for 5 days plus self care.
If pregnant
Offer erythromycin for 5 days plus self care.
FOR ALL PATIENTS: If symptoms worsen rapidly or significantly at any time, OR do not improve after completion of treatment course -> Onward referral.
FOR ALL PATIENTS: share self-care and safety-netting advice using TARGET Respiratory Tract Infection leaflets