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Tell patients to use paracetamol for sore throat, urge NICE and PHE

Healthcare professionals need to step up advice to curb antibiotic use for this condition

Caroline White

Friday, 26 January 2018

Healthcare professionals should tell their patients to take paracetamol rather than antibiotics for a sore throat, say the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE) in final recommendations published today for the treatment of the condition.

Of all GP appointments made in the UK for respiratory tract infections, one in four (27%) are for sore throats.

The evidence reviewed by NICE found that most sore throats are triggered by a viral infection. Most people will get better without antibiotics, and usually have symptoms for up to a week. But research* suggests that antibiotics are prescribed in 60% of these cases.
NICE says healthcare professionals should help people to manage their symptoms with pain relief, such as paracetamol or ibuprofen.

Some adults may wish to try throat sweets containing either a local anaesthetic, a non-steroidal anti-inflammatory drug (NSAID) or an antiseptic, says NICE. But they should be advised that these may only help to reduce pain by a small amount.

Dr Tessa Lewis, GP and chair of the Managing Common Infections Guidance Committee, said: “A sore throat can be very painful, making you feel tired and unwell for about a week. But in most cases antibiotics will not make much difference. Instead, we should drink plenty of fluids and rest.

“Paracetamol can help to relieve pain and control temperature. Medicated lozenges might not reduce the pain by much, but some people may choose to use them.”

Professor Cliodna McNulty, head of Primary Care Unit, PHE, said: “Antibiotics are a precious resource and it’s important that they are only used when they are really needed. For a sore throat, evidence shows that antibiotics make little difference to length or severity of illness, unless symptoms are much more severe. While a sore throat can be painful, there are other ways to control the symptoms including taking paracetamol and medicated lozenges.”

The guidance says people who have a sore throat caused by streptococcal bacteria are more likely to benefit from antibiotics. It highlights two scoring tools, FeverPAIN and Centor, as useful ways for prescribers to identify these patients.

For FeverPAIN the patient scores one for each of the following: fever (during previous 24 hours); pus on tonsils; attend rapidly (within three days after onset of symptoms); severely Inflamed tonsils; no cough or inflammation of mucus membranes.

A score of 0-1 means the patient is unlikely (13-18% chance) to have a bacteria-induced sore throat. The chance increases as the score gets higher; 2-3 (34-40%) and 4-5 (62-65%).

For Centor the patient scores one for each of the following: tonsillar exudate; tender anterior cervical lymphadenopathy or lymphadenitis; history of fever (over 38°C); absence of cough.

A score of 0-2 is thought to be associated with a 3-17% likelihood of the patient having a bacteria-induced sore throat. A score of 3-4 is thought to be associated with a 32-56% likelihood.

The FeverPAIN and Centor criteria can be used to assess the patient and score them on particular criteria.

Professor Gillian Leng, deputy chief executive at NICE, said: “People who need [antibiotics] should be given them, and our advice will support those decisions. But it is clear that routine prescribing in all cases isn’t appropriate.

“We are living in a world where bacteria are becoming resistant to antibiotics. It is vital these medicines are protected, and only used when they are effective.”

Professor Helen Stokes Lampard, chair of the Royal College of GPs added: "Antibiotics are essential drugs but the bacteria causing infections are increasingly becoming resistant to them, and when that happens they cease to work. We must use them sparingly and only when they are appropriate in order to help curb this dangerous and global trend – and we need our patients' help with this by them understanding that antibiotics are not a cure for every ill.

"The RCGP has worked with Public Health England to develop the TARGET Antibiotics toolkit to support GPs and other healthcare professionals in the appropriate prescribing of antibiotics."

*Gulliford MC, Dregan A, Moore MV, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open 2014;4:e006245. doi: 10.1136/bmjopen-2014-006245

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