What is the recommended course of treatment for a patient with a sore throat and a burning sensation throughout the body, with worsening symptoms as the day progresses?

Management of Sore Throat with Systemic Burning Sensation

Start with ibuprofen or paracetamol (acetaminophen) immediately for symptomatic relief, as both are first-line analgesics with strong evidence for acute pharyngitis, with ibuprofen showing slightly better pain relief efficacy. 1

Immediate Symptomatic Management

• Ibuprofen is the preferred first-line systemic analgesic for acute pharyngitis, with paracetamol as an equally effective alternative 1, 2
• Ibuprofen demonstrates slightly better efficacy than paracetamol for pain relief, particularly after 2 hours of administration 1
• Both medications are safe when used according to directions for short-term treatment, with low risk of adverse effects 1

Assessment for Bacterial Infection

Before considering antibiotics, calculate the Centor score to determine likelihood of Group A streptococcal infection 2:

• Fever (1 point)
• Tonsillar exudates (1 point)
• Tender anterior cervical lymphadenopathy (1 point)
• Absence of cough (1 point)

Centor Score 0-2 (Low Risk)

• Do NOT prescribe antibiotics - the presentation is too mild and antibiotics provide no meaningful benefit 1, 2, 3
• Continue symptomatic management with ibuprofen or paracetamol 1, 3
• Reassure the patient that typical sore throat duration is less than one week 2
• Most cases (>65%) are viral in origin and do not require antibiotics 2

Centor Score 3-4 (Higher Risk)

• Consider rapid antigen testing (RAT) for streptococcal infection 2
• Discuss with the patient that antibiotic benefits are modest - they only shorten symptoms by 1-2 days 2
• Weigh modest benefits against side effects, impact on microbiota, antibiotic resistance, and costs 1
• If antibiotics are indicated after shared decision-making, penicillin V twice or three times daily for 10 days is the first-choice agent 1, 2, 3

Critical Red Flags to Exclude

The "burning sensation throughout the body" warrants careful evaluation for serious conditions 4:

• Assess airway patency immediately - difficulty breathing, drooling, or stridor suggests epiglottitis or retropharyngeal abscess 4
• Look for signs of peritonsillar abscess (quinsy) - severe unilateral throat pain, trismus, uvular deviation 2
• In adolescents and young adults, be vigilant for Lemierre syndrome - severe pharyngitis with systemic toxicity requires urgent diagnosis 2
• Cherry-red epiglottis suggests Haemophilus influenzae type b infection requiring immediate intervention 5

What NOT to Use

• Do NOT use local antibiotics or antiseptics - sore throats are mainly viral and these lack efficacy data 1
• Do NOT use zinc gluconate - conflicting efficacy results and increased adverse effects 1, 3
• Do NOT use herbal remedies or acupuncture - lack of reliable efficacy data 1, 2, 3
• Corticosteroids are NOT routinely recommended - only consider in severe presentations (Centor 3-4) in conjunction with antibiotics 1, 3

Key Clinical Pitfalls

• Antibiotics do NOT prevent suppurative complications (quinsy, otitis media, sinusitis, mastoiditis) in most cases 3
• Antibiotics do NOT prevent rheumatic fever or glomerulonephritis in low-risk patients without prior rheumatic fever history 3
• The systemic "burning sensation" described is atypical for simple pharyngitis and warrants consideration of systemic viral illness, inflammatory conditions, or early signs of serious infection 4, 6
• Worsening symptoms throughout the day could indicate progressive infection requiring closer monitoring 6

Follow-Up Instructions

• Advise the patient to return immediately if they develop difficulty breathing, drooling, inability to swallow, severe unilateral throat pain, or high fever 4
• If symptoms do not improve within 3-5 days or worsen despite analgesic therapy, re-evaluation is necessary 2
• Patient education about the self-limiting nature of most sore throats (typically <1 week) helps manage expectations and reduces unnecessary antibiotic use 2, 7