NICE provides guidance on managing sore throat

NICE has issued final guidance on how GPs and other health professionals should manage acute sore throat (NG84). The guideline, developed in partnership with Public Health England (PHE), is one of a series of antimicrobial prescribing guidelines covering the management of common infections; acute sinusitis has already been published (NG79) and other guidelines still in development include acute otitis media and lower urinary tract infections.

NICE says that around one in four GP appointments made for respiratory tract infections in the UK are because of a sore throat. Acute sore throat (including pharyngitis and tonsillitis) is self-limiting and most people will get better within a week without the need for antibiotic treatment, regardless of whether the cause is viral or bacterial. Nevertheless, at present antibiotics are prescribed in 60% of cases.

NICE recommends that instead of antibiotic treatment, in most cases health professionals should help people to self-manage their symptoms using pain relief medication such as paracetamol or ibuprofen, along with an adequate intake of fluids. Medicated lozenges containing either a local anaesthetic, an NSAID or an antiseptic can also be tried, but they may only help to reduce pain by a small amount.

However, NICE advises that some patients may benefit from antibiotic treatment, and health professionals should use the symptom scoring tools FeverPAIN and Centor to better identify such patients. If the FeverPAIN score is 0 or 1 or the Centor score 0, 1 or 2, an antibiotic should not be offered, but the patient should be advised to seek medical help if symptoms worsen rapidly or do not start to improve after one week. A back-up antibiotic prescription can be considered in patients with a FeverPAIN score of 2 or 3, and the patient should be advised to use the prescription if there is no improvement in three to five days or if symptoms worsen rapidly. An immediate antibiotic prescription should only be considered in patients with a FeverPAIN score of 4 or 5 or a Centor score of 3 or 4.

If the patient is systemically very unwell, has symptoms and signs of a more serious condition or has a high risk of complications, an immediate antibiotic prescription should be offered, and they should be referred to hospital if the infection is severe.

NICE provides a useful two-page visual summary of the recommendations on its website, including a treatment algorithm and a table of recommended antibiotic regimens, if antibiotic therapy is deemed necessary. The antibiotic of first choice in both children and adults is phenoxymethylpenicillin; clarithromycin or erythromycin are alternative choices for patients with penicillin allergy or intolerance.

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