Due to the increased prevalence of Group A Strep (GAS) during winter 2022-23 national guidance on how we treat sore throats was updated (National advice to lower the threshold for antibiotics was rescinded 15ht Feb 2023)
Sore Throat
FeverPAIN = 1 point for each of
- Fever
- Purulent tonsillar exudate
- Attendance within 3 days of onset
- severely Inflamed tonsils
- No cough/coryza
Score
- FeverPAIN = 0 or 1/ Centor = 0,1 or 2 – no antibiotics, self care advice
- FeverPAIN = 2 or3 – no antibiotics or a script for 3-5 days time if no better, self care advice
- FeverPAIN = 4 or 5 / Centor 3 or 4 = give Antibiotics immediately, self care advice
Sore throat advice – see HERE
Scarlet Fever – NICE
- First symptoms: often include a sore throat, headache, fever, nausea and vomiting
- After 12 to 48 hours the characteristic fine red rash develops (if you touch it, it feels like sandpaper)
- Further Signs/Symps:
- fever over 38.3º C
- white coating on the tongue which peels a few days later, leaving the tongue looking red and swollen (known as ‘strawberry tongue’)
- swollen glands in the neck
- feeling tired and unwell
- flushed red face, but pale around the mouth. The flushed face may appear more ‘sunburnt’ on darker skin
- peeling skin on the fingertips, toes and groin area, as the rash fades
Treatment: 10/7 antibiotics (first line Penicillin V)
Invasive Group A Strep
Rare but severe – consider if features of bacterial pneumonia OR current GAS Infection/Contact
Treatment: As SEPSIS
Throat Swabs
Only required in :
- Diagnostic uncertainty
- 1st line treatment failure
- Invasive GAS to aid sensitivities
Treatment
- 1st line: Pen V (if no liquid can use crushed tablets)
- Alternatives: Amoxicillin, Macrolides, Cefalexin
- Co-trimoxazole option if severe penicillin allergy and no macrolide available
- Length: 10 days for microbiological cure (scarlet fever) – but symptomatic cure may typically 5days (encourage to complete course
- Parent Advice sheet – HERE
References
