Pharyngitis — UKMLA MCQ

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A 28-year-old presents to general practice with a 2-day history of sore throat. They are not systemically unwell, have no features of a suppurative complication, are not immunocompromised, and have a Centor score of 1. What is the single best management?

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Correct answer: C — Offer symptomatic treatment and safety-netting without an antibiotic

The correct answer is C. A Centor score of 1 places this otherwise well adult in the group unlikely to benefit from antibiotics. NICE recommends no antibiotic for Centor scores of 0–2. Management should include analgesia such as paracetamol or, if suitable, ibuprofen, adequate fluids, and advice to seek review if symptoms worsen rapidly, the patient becomes systemically unwell, or symptoms do not begin improving within about 1 week. Phenoxymethylpenicillin (A) is a first-line antibiotic when an antibiotic is indicated, but it is unnecessary here. Starting antibiotics while awaiting a throat culture (B) is inconsistent with the low clinical probability and antimicrobial stewardship. Co-amoxiclav (D) and azithromycin (E) are also unnecessary and are not routine first-line treatments for uncomplicated acute sore throat.

Reference: National Institute for Health and Care Excellence. NG84, Sore throat (acute): antimicrobial prescribing, recommendations 1.1.6–1.1.7. Current guidance accessed 14 August 2026. https://www.nice.org.uk/guidance/ng84/chapter/Recommendations