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Simple score identifies patients needing antibiotics for sore throat

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UK researchers have devised a simple clinical score to assess whether patients presenting with a sore throat would benefit from antibiotics or not.

The nine-item FeverPAIN score can be used to decide whether to prescribe patients an antibiotic immediately or to give them a delayed prescription, according to a team from Southampton University. They suggest routine use of the score could cut antibiotic prescriptions by almost 30%.

The score includes asking whether a patient has had a fever in the past 24 hours, a pus infection, attendance within three days, inflamed tonsils and no cough or cold symptoms.

The study included 631 patients with an acute sore throat. Researchers compared use of the score – with or without rapid antigen testing – with a delayed prescription, where patients were told to pick up a script three to five days later if their symptoms did not settle or worsened.

Patients with four or five of the features in the FeverPAIN test were prescribed antibiotics immediately. A delayed antibiotic prescription was offered to those with two or three features and none for only one or no features.

The test led to a 29% reduction in antibiotic use, compared with the delayed prescription approach, the researchers found.

However, they said using the rapid antigen test as well as the FeverPAIN test for patients with streptococci symptoms had little impact.

Study co-author Dr Michael Moore, a reader in primary care research at Southampton University, said using the clinical score to target treatment for acute sore throat was “likely to reduce antibiotic use and improve symptom control”.

He added that the score also identified patients at low risk of streptococcal infection, giving the clinician the “confidence” not to use antibiotics.

“If you select those at the highest risk of streptococcal infection then antibiotics can be more targeted at the people who are most likely to get symptom benefit,” he said.

An easy to use version of the score is available online.

The study is published online in the British Medical Journal and was funded by the National Institute for Health Research’s heath technology assessment programme.

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