In the majority of cases, a sore throat will clear up on its own without the need for antibiotic treatment.

Sore throats are most often caused by viral infections such as cold and flu. If a person is otherwise healthy, their immune system will be able to tackle these infections without the need for treatment.

What’s more, antibiotics are only effective against bacterial infections. They don’t work on viruses; so if a viral infection is the cause, then antibiotic treatment won’t help.

There are however some uncommon instances in which someone with a sore throat may be advised to take antibiotics, if they have a more serious bacterial infection.

In this post, we’ll look at:

  • what causes sore throats
  • new NHS and NICE guidance
  • the FeverPAIN scoring system
  • why prescribing antibiotics for sore throats should be avoided unless absolutely necessary
  • and when a sore throat requires a doctor’s attention

What causes sore throats?

A sore throat is typically characterised by dryness, pain or discomfort in throat (particularly when swallowing). This might be accompanied by inflammation and swelling of the tonsils.

There are several reasons why someone might get a sore throat. Conditions which are sometimes responsible include:

  • allergies
  • acid reflux (GORD)
  • cold or flu
  • laryngitis
  • tonsillitis
  • glandular fever
  • and streptococcus A.

People who smoke are also more prone to getting a sore throat.

Someone who has a sore throat due to allergies will usually see an improvement after they have got their symptoms under control. Similarly, managing acid reflux can help to ease a sore throat related to this condition.

Colds and flu tend to pass within 1-2 weeks in the majority of cases, with rest and drinking plenty of fluids.

Laryngitis and glandular fever are caused by viral infections most of the time. Laryngitis will usually resolve by itself after a few days, but for glandular fever this might take longer.

Tonsillitis can be caused by a virus or bacteria, but in most cases is also self-limiting. Less commonly, antibiotic treatment may be advised if symptoms persist and a bacterial infection is the suspected cause.

New guidance

In January, NICE and the NHS updated their recommendations on the treatment of sore throats.

They advised that taking an over-the-counter painkiller such as paracetamol and, for adults, gargling with salty water are typically sufficient to help discomfort associated with a sore throat, and reduce the span of the infection. They added that seeing a doctor about a sore throat is only usually necessary if symptoms don’t go away after a week or more.

There several point-of-care tests available for strep A infections (which can cause sore throats and sometimes require antibiotics). Most of them involve taking a swab sample from the throat.

Even when strep A is present, antibiotics may not be necessary, as infections of this type can often be self-limiting.

The FeverPAIN score

NICE have also developed a scoring system called FeverPAIN, to help GPs determine whether antibiotic treatment is worth considering. On this scale, a patient is given a score out of five, with one point assigned for each of the below:

  • presence of a fever within the last 24 hours
  • pus on the tonsils
  • severe inflammation of the tonsils
  • needing to see the GP urgently (in 3 days or less since the onset of symptoms)
  • having no cough or inflammation of inner nasal tissues.

It’s unlikely antibiotic treatment will be of any help to patients scoring one or less.

Patients scoring two or three may be given self-care advice and asked to return after a week if symptoms do not get better or deteriorate, or be issued a ‘back-up’ prescription to be used in these instances.

Scores of four or five are more likely to be cases where an antibiotic might help; but this doesn’t necessarily mean one will be issued. The GP will consider other factors, and again may recommend that the patient comes back if symptoms persist or get worse.

An antibiotic might be given straight away if the patient is severely unwell, or has a high risk of developing complications. In some instances, referral to hospital for treatment might be recommended.

Why are antibiotics not always suitable?

Antibiotics are engineered to tackle bacterial infections, and there are several different classes. Some are broad spectrum, meaning that they work on several different types of bacteria; whereas others have a much more narrow field of use.

The usefulness of an antibiotic medicine is finite. Over time, bacteria develops a resistance to the microbes in an antibiotic; so the medicine will become less effective over time. Some bacteria tend to be quicker and more aggressive in developing a resistance than others.

Nerissae gonorrhoeae, the bacteria responsible for gonorrhoea, is a prime example. Over the past few decades this infection has repeatedly developed resistance to several types of antibiotic, and now a combination of two is required to treat it.

So the more antibiotics are used (especially in cases where they aren’t necessary) the sooner and more likely they are to become ineffective. Responsible stewardship then is vital to prolonging their efficacy; and this means only prescribing them in cases where they are needed and likely to be beneficial.

Historically, doctors in primary care have often prescribed antibiotics to help with sore throats. But as most cases of sore throats aren’t caused by bacteria (and even in cases where they are, are likely to resolve without the need for treatment), this is an area which has been identified by NICE and the NHS where better stewardship can be exercised.

When should I see a doctor about a sore throat?

Most of the time, you won’t need to see a doctor about a sore throat and it will get better by itself.

If your sore throat is proving uncomfortable, visiting your pharmacist for advice may help. They will be able to give you advice on painkillers and other methods (such as gargling salt water) to help ease symptoms.

If you:

  • have a sore throat which doesn’t go away after a week
  • have sore throats quite often
  • have other symptoms such as a fever
  • or have a higher risk of illness due to a weaker immune system

then you should see your doctor.

If you become severely ill or have any difficulty breathing, then you should seek medical attention right away.