Acute sore throat (likely streptococcal) — MRCGP AKT MCQ

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EasyENT/Infectious DiseasesAcute sore throat (likely streptococcal)MRCGP AKT UKMLA PARA PSA

A 22-year-old man presents with an acute sore throat and has a Centor score of 4. He is systemically stable and has no features of a suppurative complication. He has previously developed immediate urticaria and angioedema after taking penicillin. Following discussion of the benefits and harms, an immediate antibiotic prescription is agreed. Which antibiotic is the most appropriate choice?

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Correct answer: B — Clarithromycin

Clarithromycin is the alternative first-choice antibiotic for a non-pregnant adult with acute sore throat when antibiotic treatment is selected and there is penicillin allergy or intolerance. A Centor score of 4 identifies someone most likely to benefit, although NICE permits either an immediate or a back-up prescription; the stem establishes that immediate treatment has been agreed. Phenoxymethylpenicillin is normally first choice but is unsuitable after immediate penicillin hypersensitivity. Amoxicillin and co-amoxiclav also contain a penicillin and should be avoided; co-amoxiclav is additionally unnecessarily broad-spectrum. Erythromycin is the preferred macrolide when one is required during pregnancy, rather than the routine alternative for this patient.

Reference: National Institute for Health and Care Excellence. NG84: Sore throat (acute): antimicrobial prescribing, recommendations 1.1.10 and 1.3.1. Published 2018; updated 2025. https://www.nice.org.uk/guidance/ng84/chapter/recommendations