Acute Sore Throat


On 14th December 2022, Scottish Antimicrobial Prescribing Group published more detailed advice on the Antibiotic Management of Group A Streptococcus infection in children aged 18 and under.  Link
A table of therapy recommendations is provided with an order of preference and includes alternative options if the first line choice is unavailable due to increased demand.  The duration of therapy has been clarified and there is a link to important safety netting advice for parents and carers.  The advice will be reviewed again in January 2023.


Amoxicillin and other broad-spectrum penicillin should not be used for the blind treatment of sore throat. Maculopapular rashes occur commonly with ampicillin and amoxicillin but are not usually related to true penicillin allergy. They almost always occur in people with infectious mononucleosis.

Avoid antibiotics as 90% resolve in 7 days without, and pain only reduced by 16 hours.

Use FeverPAIN Score: Fever in last 24h, Purulence, Attend rapidly under 3d, severely Inflamed tonsils, No cough or coryza. 

Score 0-1: 13-18% streptococci, use NO antibiotic strategy;
2-3: 34-40% streptococci, use 3 day back-up antibiotic;
>4: 62-65% streptococci, use immediate antibiotic if severe, or 48hr short backup prescription.

Always share self-care advice & safety net.
Antibiotics to prevent Quinsy NNT >4000.
Antibiotics to prevent Otitis media NNT 200.

For further information on children see Empiric Antibiotic Therapy poster.

For glossary of terms see Glossary

Drug details

Phenoxymethylpenicillin 500mg four times daily or 1 gram twice daily (increase to four times daily when severe)
See BNFC for children dosing information.

5 days.

10 days for recurrent infection or high suspicion/confirmation of streptococcal throat infection

Penicillin Allergy

Clarithromycin 500mg twice daily
See BNFC for children dosing information.

5 days

Last reviewed: 02 September 2019

Next review: 02 September 2022

Author(s): Antimicrobial Management Team

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT151