Acute Sore Throat Summary

Key Points:

Diagnostic Criteria:

Management:

Red Flags:

Acute Sore Throat

Diagnosis and Management Guidelines

Sore throat occurs when an acute upper respiratory tract infection affects the mucosa of the throat. Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. Acute pharyngitis is inflammation of the part of the throat behind the soft palate (oropharynx). The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as 'acute sore throat'.

Causes

Common infectious causes

  • Rhinovirus, coronavirus, parainfluenza virus
  • Influenza types A and B
  • Streptococcal infection
    • Group A beta-haemolytic streptococcus (GABHS)
    • Group C and G beta-haemolytic streptococci
  • Adenovirus
  • Herpes simplex virus type 1/2
  • Epstein-Barr virus
  • Fusobacterium necrophorum

Rarer infectious causes

  • Haemophilus influenzae type b
  • Enteroviruses
  • Measles virus
  • Candida albicans
  • Neisseria gonorrhoeae
  • Corynebacterium diphtheria
  • Arcanobacterium haemolyticum
  • HIV-1

Non-infectious causes

  • Physical irritation
  • Hayfever
  • GERD
  • Kawasaki disease
  • Oral mucositis
  • Haematological disorders
  • Drug side effects
  • Oropharyngeal cancer

Assessment

Diagnosis

Diagnosis is clinical and investigations are not performed routinely.

Note: For high-risk cases, arrange rapid antigen test for group A streptococcus. Negative tests in children should be followed by throat culture.

Centor Criteria

Score 1 point for each (max 4):

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy
  • History of fever >38°C
  • Absence of cough

Interpretation:

  • 0-2 points: 3-17% strep likelihood
  • 3-4 points: 32-56% strep likelihood

FeverPAIN Criteria

Score 1 point for each (max 5):

  • Fever in last 24 hours
  • Purulence (exudate)
  • Attend within 3 days
  • Severely inflamed tonsils
  • No cough/coryza

Interpretation:

  • 0-1 points: 13-18% strep likelihood
  • 2-3 points: 34-40% strep likelihood
  • 4-5 points: 62-65% strep likelihood

Management

Acute sore throat is self-limiting (typically 1 week). Most people improve without antibiotics.

FeverPAIN 0-1 / Centor 0-2

  • No antibiotics
  • Advise on self-care
  • Seek help if worsening or no improvement after 1 week

FeverPAIN 2-3

  • Consider no antibiotic or backup prescription
  • Use backup if no improvement in 3-5 days

FeverPAIN 4-5 / Centor 3-4

  • Consider immediate or backup antibiotics

Systemically unwell/high-risk: Offer immediate antibiotics and consider referral for severe infections/complications.

Antibiotic Choices

Complications

Local Extension

  • Otitis media
  • Sinusitis
  • Peritonsillar abscess (quinsy)
  • Parapharyngeal/retropharyngeal abscess
  • Acute epiglottitis

Systemic

  • Metastatic infection (brain abscess, endocarditis)
  • Streptococcal toxic shock
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis