From the Guidelines
Evaluation of a sore throat should begin with a thorough history and physical examination to determine the likely cause, and antibiotics should only be prescribed if group A streptococcal pharyngitis is confirmed by rapid antigen detection test and/or culture, as most cases are caused by viruses and antibiotics have modest benefits and potential adverse effects 1. When assessing a patient with a sore throat, it is essential to consider symptoms such as fever, difficulty swallowing, duration of symptoms, and presence of cough or nasal congestion. During the physical examination, look for signs like throat redness, swelling, white patches, enlarged tonsils, and swollen lymph nodes in the neck.
- A rapid strep test or throat culture may be necessary if streptococcal pharyngitis is suspected, particularly with fever, absence of cough, tender lymph nodes, and tonsillar exudate.
- For viral sore throats, which are most common, treatment includes rest, hydration, warm salt water gargles, and over-the-counter pain relievers like acetaminophen or ibuprofen.
- If strep throat is confirmed, antibiotics such as penicillin V or amoxicillin are recommended for a duration of 10 days to eradicate group A Streptococcus from the pharynx, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1. It is crucial to note that antibiotics are not recommended for chronic group A Streptococcus carriers, and tonsillectomy solely to reduce the frequency of group A streptococcal pharyngitis in adults is not recommended 1.
- Patients can be assured that the typical course of a sore throat is less than 1 week, and antibiotics are usually not needed because they do little to alleviate symptoms and may have adverse effects 1.
From the Research
Sore Throat Evaluation
- Sore throat is a common reason for consultation of family physicians, usually triggered by infections of the pharynx, with less than 35% of cases caused by bacterial infections 2.
- Evidence-based guideline recommendations are available to reduce non-indicated administration of antibiotics in the treatment of sore throat, including the use of clinical scores such as Centor, McIsaac, and FeverPAIN to assess the risk of bacterial pharyngitis 2, 3.
- Patients with acute sore throat should be encouraged in self-management, with ibuprofen and naproxen recommended for symptomatic treatment, and antibiotics considered only if clinical scores suggest a high risk of bacterial pharyngitis 2.
- The optimal clinical management of adults with sore throat depends on both the clinical probability of a group A streptococcal infection and clinical judgments that incorporate individual patient and practice circumstances 4.
- Accurate identification of the cause of pharyngitis is important for appropriate treatment, with clinical scoring systems and diagnostic tests recommended to identify group A beta-hemolytic streptococcus, which warrants guideline-driven therapy 5, 6.
Diagnosis and Treatment
- Rapid antigen detection tests and throat cultures can be used with clinical findings to identify the inciting organism, with penicillin and amoxicillin recommended as first-line antibiotics for group A beta-hemolytic streptococcal pharyngitis 3, 6.
- Steroids are not recommended for symptomatic treatment, and tonsillectomy is rarely recommended as a preventive measure, with specific thresholds for considering surgery 3.
- A thorough history is key to diagnosing pharyngitis, with rapid antigen detection tests reserved for concerns about antibiotic initiation, and physicians should exercise restraint in antibiotic initiation for pharyngitis 6.
Clinical Scores and Antibiotic Use
- Clinical scores such as Centor, McIsaac, and FeverPAIN can be used to assess the risk of bacterial pharyngitis, with antibiotics considered only if clinical scores suggest a high risk 2, 3.
- The use of clinical scores can help reduce non-indicated administration of antibiotics in the treatment of sore throat, with a risk-adapted approach recommended for antibiotic use 2, 4.