Pharyngitis / Sore Throat / Tonsillitis

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 7 days to resolve.
  • Antibiotics make little difference to how long symptoms last or the number of people whose symptoms improve.
  • Withholding antibiotics is unlikely to lead to complications 
  • Offer all patients advice about self-care and to seek medical help if symptoms worsen significantly.
  • Reassess if symptoms worsen rapidly or significantly, taking account of: alternative diagnoses such as scarlet fever or glandular fever or any symptoms or signs suggesting a more serious illness or condition.
  • Consider referral to hospital if they have acute sore throat associated with severe systemic infection or severe suppurative complications (such as abscess).
  • If scarlet fever is suspected it is advisable to treat for 10 days duration.

feverpain scoring system

Symptomatic Relief

  • Consider analgesia:  paracetamol (or ibuprofen where appropriate).
  • Advise patient about adequate intake of fluids.
  • Patients report symptom relief from using over-the-counter products such as topical anaesthetics sprays and medicated lozenges containing local anaesthetics.
  • Advise to consult pharmacist for symptom relief.

Treatment

Pharngitis / Sore Throat / Tonsillitis Antibiotic Treatment Table

Consider no antibiotic or delayed antibiotic strategy
Use FEVERPAIN Score to identify those most likely to benefit from antibiotics.

Score 0-1: Do not offer antibiotic

Score 2-3: Offer delayed antibiotic

Score 4-5: Offer immediate antibiotic prescription

If antibiotics deemed clinically indicated:
Drug Dose Duration Notes
Adults: 1st choice options

Phenoxymethylpenicillin

 

 

 

 

666mg every 6 hours
(Calvepen®)

OR 500mg every 6 hours
(Kopen®)

 

 

5 Days

 

 

 

 

Avoid in penicillin allergy.

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

To optimise absorption, take on empty stomach

Adults: 2nd choice options

Amoxicillin 

 

 

 

500mg every 8 hours

 

 

 

5 days

 

 

 

Avoid in penicillin allergy.

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

Cefalexin

 

 

 

500mg every 6  hours

 

 

 

5 Days

 

 

 

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

Cephalosporins should not be used in severe penicillin allergy.

Clarithromycin

 

 

 

 

 

 

500mg every 12 hours

 

 

 

 

 

 

5 Days

 

 

 

 

 

 

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

Macrolides should be used with caution in pregnancy. Clarithromycin suitable only in 2nd and 3rd trimester in pregnancy.

Alternative macrolide for all trimesters of pregnancy: Azithromycin 500mg stat then 250mg every 24 hours from Day 2 to Day 5.

Children: 1st choice options

Phenoxymethylpenicillin suspension

 

 

 

 

See Phenoxymethylpenicillin dosing for children

 

 

 

 

 5 Days

 

 

 

 

Avoid in penicillin allergy.

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

To optimise absorption, take on empty stomach.

Children: 2nd choice options

Amoxicillin suspension

 

 

 

See Amoxicillin dosing for children

 

 

 

 5 Days

 

 

 

Avoid in penicillin allergy.

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

 Cefalexin suspension

 

 

 

See Cefalexin dosing for children

 

 

 

 5 Days

 

 

 

 

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

Cephalosporins should not be used in severe penicillin allergy.

Clarithromycin suspension

 

 

See Clarithromycin dosing for children

 

 

5 days

 

 

Depending on clinical response, duration can be extended to 10 days in total.

If scarlet fever is suspected it is advisable to treat for 10 days duration.

 

Pharyngitis Treatment Table December 2022.pdf (size 428 KB)

Patient Information

Safe Prescribing (visit the safe prescribing page)

Reviewed December 2022

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