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  • Dr Geraint Preest

Antibiotics and sore throats

Most sore throats settle down within a week without antibiotics. This is because most sore throats are caused by viruses and viruses cannot be treated with antibiotics. This is important, because there is a growing problem with antibiotic resistance and many experts believe that inappropriate use of antibiotics is a leading cause of resistance. Not only will we cause problems with resistance if we issue antibiotics when there is no need, but we can also cause harm because antibiotics can cause all sorts of problems - relatively "trivial" problems like rashes to more serious and potentially life threatening problems like "anaphylaxis" (which is a severe allergy reaction) and they can also predispose patients to infections with a bug called Clostridium Difficile. Clostridium Difficile causes a severe diarrhoeal illness that can be very serious in vulnerable groups, such as the elderly.

Here's a great short film about antimicrobial resistance by the ABMU pacesetter team:

How do our Minor illness nurses (and Doctors) decide who needs antibiotics for a sore throat? It can be tricky in some cases, but generally speaking, we use a scoring system called a "CENTOR" score to guide us. Using this scoring system we "score" the presence of a number of symptoms and signs. Each of the following score 1 point:

  • Tonsillar exudate - in other words, "pus" on the tonsils (we've put a photo at the end, if you're not too queasy)

  • Tender anterior cervical lymph nodes - these are tender enlarged glands in the neck like little peas or marbles.

  • Absence of cough (Yes, that's right, if you haven't got a cough, it scores 1 point)

  • History of fever (You've measured your temperature and it's been over 37.5 degrees centigrade)

Each of these symptoms and signs attracts 1 point (out of a maximum of 4 for all of them). If you've got a score of 3 or 4 then you have a 40-60% chance of having a bacterial sore throat. If you have a score of 0 or 1, then there's an 80% chance that it's viral and unlikely to benefit from antibiotics.

What should you do if you have a sore throat? If you're feeling otherwise well, then you should visit the Chemist for advice. Chemists are highly trained to treat minor illnesses like this BUT also to send patients to us if they feel that your symptoms may be more serious.

Patients who arrive at our surgery are seen by our minor illness nurses and the majority are dealt with by our nurses (including those who need antibiotics). If there is a rare, very serious cause for your sore throat or things aren't as straightforward as they seem, the nurses can fast track an assessment with a GP.

How long do sore throats normally last? How long do coughs normally last? - You'll find the answer in the link at the end of this blog and the answer may surprise you.

So, that's sore throats. If you'd like to read more about antibiotic resistance and minor illness, we've put some really good links at the end of this blog.

If you're on Twitter, we also have a local antibiotic superstar Pharmacist called Avril Tucker who's doing lots of great work to raise awareness about antibiotic resistance and when to use appropriately. Avril can be found @avrilbiotic

Finally, here's a photo of tonsillar exudate (see all that white yucky stuff at the back there?):

(Photo credit (c) Mr Jarrod Windsor 2018)

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