Pharyngitis / Sore Throat / Tonsillitis

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

• Check our Safe Prescribing page for more information
• Check our Tips on prescribing in penicillin allergy for more information

Comments from Expert Advisory Committee

• The majority of sore throats are viral; most patients do not benefit from antibiotics. Consider a delayed antibiotic strategy and explain soreness will take about 8 days to resolve.
• Antibiotics make little difference to how long symptoms last or the number of people whose symptoms improve
• Side effects of antibiotics include nausea and diarrhoea
• Withholding antibiotics is unlikely to lead to complications (a large UK Cohort study conducted in 610 UK general practices to determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis ,empyema, meningitis, intracranial abscess, and Lemierre’ syndrome is higher in general practices that prescribe fewer antibiotics for self-limiting respiratory tract infections (RTIs).It involved 45.5 million person years of follow-up from 2005 to 2014.It concluded that If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, they might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome were similar in frequency at low prescribing and high prescribing practices)

Under dosing is common please follow recommended dose and durations and use age and weight based dosing for paediatric population

Phenoxymethylpenicillin is effective treatment for Group A strep infections GAS

Phenoxymethylpenicillin suspension is available in two flavours; Calvepen® (caramel) and Kopen® (orange).

Symptomatic Relief

• Use paracetamol and/or ibuprofen for pain relief
• Weak evidence supports the use of a once off oral dose of 10mg dexamethasone in adults with sore throat. This has been shown to reduce throat pain at 48 hours compared to placebo.
• Patients reports symptom relief from using over-the-counter products such as topical anaesthetics sprays (e.g. benzydamine) and lozenges (e.g. benzocaine)

Treatment

Consider a no or delayed antibiotic strategy.^A+

If antibiotics deemed clinically indicated: