Infection
Acute sore throat
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Phenoxymethylpenicillin oral 500mg 6 hourly (increased if necessary up to 1g 6 hourly) for 5-10 days

If true penicillin / beta-lactam allergy:

Doxycycline oral 200mg stat, then 100mg once daily for 5-10 days

N.B. In pregnant patients, doxycycline is contraindicated. See here for an alternative option in penicillin allergic pregnant patients.
Notes / Comments
  • If trismus, stridor or breathing difficulties are present, arrange for urgent hospital transfer and do not examine the throat as this can cause acute airway obstruction in epiglottitis.
  • Pharyngitis is usually a viral infection (50-80%). Streptococcal infection is most likely in children from 5 to 15 years and less likely in younger or older patients. In >90% of cases, resolution of symptoms occurs within 7 days without any antibiotic treatment. 
  • Group A Streptococci are universally penicillin susceptible.
  • Use the FeverPAIN score to assess need for antimicrobial prescription (1 point each):
    • Fever in last 24 hours
    • Purulent tonsillar exudate
    • Attending after duration of symptoms <3 days
    • Severely Inflamed tonsils
    • No cough or coryza
FeverPAIN score

Likelihood of S. pyogenes

Prescription strategy

0-1

13-18%

antimicrobial not advised

2-3

34-40%

delayed prescription (3 days)

>4

62-65%

Immediate treatment if severe, or 48 hour delayed prescription
  • Do not take throat swabs routinely, even if the sore throat persists.  Throat swabs have poor specificity and sensitivity.

 

 

Guideline reviewed February 2025
Page updated April 2025



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