Pharyngitis / Sore Throat / Tonsillitis

Consider a no or delayed antibiotic strategy A+

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board website or the printed Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide. Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.

Comments from Expert Advisory Committee

  1. 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. Patients with 3 of 4 Centor criteria (history of fever, purulent tonsils, cervical adenopathy, absence of cough) or history of otitis media may benefit more from antibiotics. A- Antibiotics only shorten duration of symptoms by 8 hours. A+
  2. Antibiotics to prevent otitis media NNT 200, A+ Quinsy NNT >4000. B-
  3. Penicillin for 7 days is more effective than 3 days. B+ Twice daily higher dose can also be used. A- QDS may be more appropriate if severe. D
  4. Phenoxymethylpenecillin is effective treatment for Invasive Group A strep infections iGAS -use higher dose qds for 10 days . See GP Information on Invasive Group A Strep from ICGP.
  5. Phenoxymethylpenicillin suspension is available in two flavours; Calvepen® (caramel) and Kopen® (orange).

Symptomatic Relief

  • Discomfort on swallowing – lozenges containing benzocaine or flurbiprofen. Use oral parecetomol or ibuprofen for stronger pain relief
  • Sore, ‘tickly’ throat – demulcent pastilles. Sucking a lozenze or pastille promotes saliva production which lubricates and soothes the throat. Main disadvantage; high sugar content though sugar-free preparations are available. 
  • Local analgesia - antiinflammatory spray or mouthwash (e.g. benzydamine)


Consider a no or delayed antibiotic strategy.A+

If antibiotics deemed clinically indicated:

Treatment Dose TX Duration
First line Phenoxymethylpenicillin 666 mg QDS 10 days
Clarithromycin, if allergic to penicillin 500 mg BD 10 days
First line Phenoxymethylpenicillin suspension See Phenoxymethylpenicillin dosing for children 10 days
Clarithromycin, if allergic to penicillin See Clarithromycin dosing for Children 10 days

Patient Information

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments

We recommend patients use the website developed by HSE/ICGP/IPU partnership for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Reviewed June 2016

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