What is the treatment for a patient presenting with a sore throat, headache, and fever?

Treatment of Sore Throat with Fever and Headache

Start with ibuprofen or paracetamol (acetaminophen) for symptom relief, then use the Centor score to determine if antibiotics are warranted—only prescribe penicillin V if the patient scores 3-4 Centor criteria after discussing the modest benefits versus risks. 1

Initial Symptomatic Management

• Either ibuprofen or paracetamol are equally effective first-line treatments for acute sore throat symptoms 1, 2
• Both medications reduce throat pain, headache, and fever with comparable efficacy 3, 4
• Administer standard doses: paracetamol 500-1000 mg or ibuprofen 400-600 mg 2, 5
• Symptomatic treatment alone is appropriate for most patients, as 82% will be symptom-free within one week without antibiotics 6

Risk Stratification Using Centor Criteria

Apply the Centor score immediately to guide antibiotic decision-making 1, 2:

The Centor criteria include:

• Fever (by history or measurement)
• Tonsillar exudates
• Tender anterior cervical lymphadenopathy
• Absence of cough 2, 7

Centor Score 0-2 (Low Risk)

• Do NOT prescribe antibiotics 1, 7
• Continue symptomatic treatment only
• Antibiotics provide no meaningful benefit in this group and contribute to antimicrobial resistance 1

Centor Score 3-4 (High Risk)

• Consider antibiotics only after discussing modest benefits versus risks with the patient 1
• Antibiotics reduce sore throat duration by approximately 16 hours at day 3, but most patients improve without treatment 6
• The benefits must be weighed against side effects, antimicrobial resistance, medicalization, and costs 1
• If proceeding with antibiotics, penicillin V twice or three times daily for 10 days is the first-choice agent 1, 2

What Antibiotics Do NOT Prevent

Common pitfall: Antibiotics are frequently overprescribed based on misconceptions about preventing complications 1:

• Antibiotics do NOT prevent suppurative complications (quinsy, acute otitis media, sinusitis, mastoiditis) in most cases 1, 2
• Antibiotics do NOT prevent rheumatic fever or glomerulonephritis in low-risk patients without prior rheumatic fever history 1, 2
• Even when indicated, antibiotics provide only modest symptom relief 1, 6

Additional Considerations

Corticosteroids

• Not routinely recommended 1
• Can be considered in adults with severe presentations (3-4 Centor criteria) in conjunction with antibiotics, but evidence shows smaller effects in typical primary care populations 1, 2

Avoid These Treatments

• Zinc gluconate is not recommended for sore throat 1, 2
• Herbal treatments and acupuncture have inconsistent evidence and should not be recommended 1, 2

Clinical Algorithm Summary

1. Immediate symptomatic relief: Prescribe ibuprofen or paracetamol 1, 2
2. Calculate Centor score: Fever + exudates + lymphadenopathy + no cough 2, 7
3. Score 0-2: Symptomatic treatment only, no antibiotics 1
4. Score 3-4: Discuss risks/benefits; if antibiotics chosen, use penicillin V for 10 days 1, 2
5. Reassure patient: Most sore throats resolve within 7 days regardless of treatment 7, 6