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Nurses told to use paracetamol for acute sore throat, not antibiotics


Healthcare professionals should tell patients that most sore throats do not need antibiotics, states guidance from the National Institute for Health and Care Excellence and Public Health England.

The two bodies said they have finalised their joint recommendations for treating acute sore throat, which are based on a review of available evidence and published today. They noted that, of all GP appointments made in the UK for respiratory tract infections, 27% were for sore throats.

“For a sore throat, evidence shows that antibiotics make little difference”

Cliodna McNulty

Most people will get better without antibiotics, usually experiencing symptoms for up to a week, they noted, but highlighted that research suggested antibiotics were prescribed in 60% of cases.

However, the new guidance said that people who have a sore throat caused by streptococcal bacteria were more likely to benefit from antibiotics. It highlighted two scoring tools, FeverPAIN and Centor as useful ways for prescribers to identify these patients (see box).

But in general, NICE and PHE said health professionals should help patients to manage their symptoms with pain relief, such as paracetamol or ibuprofen.

It added that some adults may wish to try medicated lozenges containing either a local anaesthetic, a non-steroidal anti-inflammatory drug (NSAID) or an antiseptic. Although it cautioned that they should be told these may only help to reduce pain by a small amount.


Gillian Leng

Professor Gillian Leng, deputy chief executive at NICE, said: “The evidence shows antibiotics are not an effective treatment for the majority of sore throats.

“People who need them should be given them, and our advice will support those decisions,” she said. “But it is clear that routine prescribing in all cases isn’t appropriate.

She added: “We are living in a world where bacteria are becoming resistant to antibiotics. It is vital these medicines are protected, and only used when they are effective.”

Professor Cliodna McNulty, head of the primary care unit at Public Health England, said: “Antibiotics are a precious resource and it’s important that they are only used when they are really needed.

“For a sore throat, evidence shows that antibiotics make little difference to length or severity of illness, unless symptoms are much more severe,” she said.

“While a sore throat can be painful, there are other ways to control the symptoms including taking paracetamol and medicated lozenges,” she noted.

“It is clear that routine prescribing in all cases isn’t appropriate”

Gillian Leng

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “We support the NICE recommendation today that paracetamol or ibuprofen would be the most appropriate first line treatment to manage the pain caused by a sore throat.”

She added: “The RCGP has worked with Public Health England to develop the TARGET Antibiotics toolkit to support GPs and other healthcare professionals in the appropriate prescribing of antibiotics.”


FeverPAIN and Centor work by the clinician assessing the patient and scoring them on the criteria below:

FeverPAIN – the patient scores one for each of the following:

  • Fever (during previous 24 hours)
  • Purulence (pus on tonsils)
  • Attend rapidly (within 3 days after onset of symptoms)
  • Severely Inflamed tonsils
  • No cough or coryza (inflammation of mucus membranes

A score of 0-1 means the patient is unlikely (13-18% chance) to have a bacteria-induced sore throat. The chance increases as the score gets higher; 2-3 (34-40%) and 4-5 (62-65%).

Centor – the patient scores one for each of the following:

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • History of fever (over 38°C)
  • Absence of cough

A score of 0-2 is thought to be associated with a 3-17% likelihood of the patient having a bacteria-induced sore throat. A score of 3-4 is thought to be associated with a 32-56% likelihood.


Readers' comments (5)

  • This advice/guidance is nothing new. The overuse use of antibiotics in sore throat has been an issue for years. Hopefully the public will accept and understand the rationale now it has been made the news.

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  • I got a streptococcal throat which caused nephritis. So how does a nurse make a diagnosis? Also ibubrufen exacerbates respiratory conditions such as asthma, copd, etc causes bronchospasms, gastro intestinal bleeding, heart attacks, strokes, kidney damage.

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  • It's not for the nurse to disagnose a patient, would prefer to refer to a doctor

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  • Sheenorama which century are you in? You don’t need a doctor to diagnose a sore throat. Nurses have varied knowledge and experiences that lends itself to making a safe and accurate clinical judgement. I see a ridiculous amount of people with sore throats most of which are cold related and requires self care. If I were to send these to one of the gps I work it I’ll be told off. Please stop underestimating the abilities of experienced and highly skilled nurses. Some who wants to see a doctor with a sore throat should try self care first because you will look sillly when asked what have you tried only to say nothing!!! Trust me that gets on my last nerve.

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  • Hi anonymous. That’s your opinion and this is mine. As a nurse I wouldn’t want diagnose a sore throat on the off chance that it’s something worse, after paracetamol for a few days I would pass the buck to the GP if their symptoms persisted or worsened with confidence I can do no more, you say the GP would tell you off, but that’s their job, so don’t take things too personally lovely.
    I’m living in 2018 where my pin means a lot, I’m not trained to diagnose.
    why take things so personally? When did I under estimate your ability? Who even are you? You sound burnt out, maybe time to try a new career. Have a nice day.

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