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”
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.
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”
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.