Executive summary
- Assessment: Use FeverPAIN (preferred) or Centor score to determine likelihood of Streptococcal infection.
- Stewardship: Most cases are viral. Antibiotics shorten duration by only ~16 hours. Limit use to high scores or vulnerable patients.
- Quinsy (Peritonsillar Abscess): Unilateral swelling, trismus (cant open mouth), deviated uvula -> Urgent ENT Referral.
FeverPAIN Score (0-5)
- Criteria: Fever (last 24h), Purulence (pus on tonsils), Attend rapidly (≤3 days), Inflamed tonsils (severe), No cough/coryza. (1 point each).
- Score 0-1: No antibiotics. (13-18% Strep). Safety net.
- Score 2-3: Delayed prescription (use if no better in 3-5 days).
- Score 4-5: Immediate prescription (62-65% Strep).
Treatment Regimens
- First Line: Phenoxymethylpenicillin (Penicillin V)
- Adults: 500mg qds (or 1g bd) for 5-10 days. (10 days eradicates Strep better).
- Children: Dosed by age (e.g., 250mg qds for 6-11 years).
- Penicillin Allergy:
- Clarithromycin: 250mg bd for 5 days.
- Erythromycin: 250-500mg qds for 5 days (preferred in pregnancy).
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.