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Acute Tonsillitis — MRCGP AKT MCQ

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EasyENTAcute TonsillitisMRCGP AKTUKMLAPARA

A 25-year-old presents with a severe acute sore throat, fever above 38°C, purulent tonsils, tender anterior cervical lymph nodes and no cough. The Centor score is 4. They have no penicillin allergy and are systemically very unwell, although observations are stable and there are no features of sepsis, airway compromise, quinsy or another suppurative complication. What is the most appropriate antibiotic strategy?

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Correct answer: A — Immediate phenoxymethylpenicillin

NICE advises offering an immediate antibiotic to a patient with acute sore throat who is systemically very unwell. Phenoxymethylpenicillin is the first-choice oral antibiotic in an adult without penicillin allergy. A Centor score of 4 alone would permit either an immediate or a back-up prescription, but the systemic illness makes immediate treatment the best answer here. A back-up prescription is therefore inappropriate for this presentation. Erythromycin is reserved mainly for penicillin allergy when a macrolide is required in pregnancy; clarithromycin is the usual alternative in a non-pregnant adult. Co-amoxiclav is unnecessarily broad-spectrum, while withholding antibiotics is inappropriate in someone who is systemically very unwell.

Reference: NICE. Sore throat (acute): antimicrobial prescribing (NG84), recommendations 1.1.10, 1.1.12 and 1.3.1. Published 2018; updated November 2025. https://www.nice.org.uk/guidance/ng84/chapter/recommendations