Sore Throat and Group A Strep 2022

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national guidance on how we treat sore throats was updated (National advice to lower the threshold for antibiotics was rescinded 15ht Feb 2023)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


  • 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


  • 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



Guide on a page – HERE

NHS England guide – HERE


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