BACKGROUND: Sore throat is a common reason for consultation of primary care physicians, pediatricians, and ENT specialists. The updated German clinical practice guideline on sore throat provides evidence-based recommendations for treatment in the German healthcare system. METHODS: Guideline revision by means of a systematic search of the literature for international guidelines and systematic reviews. All recommendations resulted from interdisciplinary cooperation and were agreed by formal consensus. The updated guideline applies to patients aged 3 years and over. RESULTS: In the absence of red flags such as immunosuppression, severe comorbidity, or severe systemic infection, acute sore throat is predominantly self-limiting. The mean duration is 7 days. Chronic sore throat usually has noninfectious causes. Laboratory tests are not routinely necessary. Apart from non-pharmacological self-management, ibuprofen and naproxen are recommended for symptomatic treatment. Scores can be used to assess the risk of bacterial pharyngitis: one point each is assigned for tonsil lesions, palpable cervical lymph nodes, patient age, disease course, and elevated temperature. If the risk is low (<3 points), antibiotics are not indicated; if at least moderate (3 points), delayed prescribing is recommended; if high (>3 points), antibiotics can be taken immediately. Penicillin remains the first choice, with clarithromycin as an alternative for those who do not tolerate penicillin. The antibiotic should be taken for 5-7 days. CONCLUSION: After the exclusion of red flags, antibiotic treatment is unnecessary in many cases of acute sore throat. If administration of antibiotics is still considered in spite of consultation on the usual course of tonsillopharyngitis and the low risk of complications, a risk-adapted approach using clinical scores is recommended.
BACKGROUND: Sore throat is a common reason for consultation of primary care physicians, pediatricians, and ENT specialists. The updated German clinical practice guideline on sore throat provides evidence-based recommendations for treatment in the German healthcare system. METHODS: Guideline revision by means of a systematic search of the literature for international guidelines and systematic reviews. All recommendations resulted from interdisciplinary cooperation and were agreed by formal consensus. The updated guideline applies to patients aged 3 years and over. RESULTS: In the absence of red flags such as immunosuppression, severe comorbidity, or severe systemic infection, acute sore throat is predominantly self-limiting. The mean duration is 7 days. Chronic sore throat usually has noninfectious causes. Laboratory tests are not routinely necessary. Apart from non-pharmacological self-management, ibuprofen and naproxen are recommended for symptomatic treatment. Scores can be used to assess the risk of bacterial pharyngitis: one point each is assigned for tonsil lesions, palpable cervical lymph nodes, patient age, disease course, and elevated temperature. If the risk is low (<3 points), antibiotics are not indicated; if at least moderate (3 points), delayed prescribing is recommended; if high (>3 points), antibiotics can be taken immediately. Penicillin remains the first choice, with clarithromycin as an alternative for those who do not tolerate penicillin. The antibiotic should be taken for 5-7 days. CONCLUSION: After the exclusion of red flags, antibiotic treatment is unnecessary in many cases of acute sore throat. If administration of antibiotics is still considered in spite of consultation on the usual course of tonsillopharyngitis and the low risk of complications, a risk-adapted approach using clinical scores is recommended.
Authors: Gail Nicola Hayward; Alastair D Hay; Michael V Moore; Sena Jawad; Nicola Williams; Merryn Voysey; Johanna Cook; Julie Allen; Matthew Thompson; Paul Little; Rafael Perera; Jane Wolstenholme; Kim Harman; Carl Heneghan Journal: JAMA Date: 2017-04-18 Impact factor: 56.272
Authors: Paul Little; F D Richard Hobbs; Michael Moore; David Mant; Ian Williamson; Cliodna McNulty; Ying Edith Cheng; Geraldine Leydon; Richard McManus; Joanne Kelly; Jane Barnett; Paul Glasziou; Mark Mullee Journal: BMJ Date: 2013-10-10
Authors: Beverley J Shea; Barnaby C Reeves; George Wells; Micere Thuku; Candyce Hamel; Julian Moran; David Moher; Peter Tugwell; Vivian Welch; Elizabeth Kristjansson; David A Henry Journal: BMJ Date: 2017-09-21
Authors: Paul Little; F D Richard Hobbs; Michael Moore; David Mant; Ian Williamson; Cliodna McNulty; Gemma Lasseter; M Y Edith Cheng; Geraldine Leydon; Lisa McDermott; David Turner; Rafael Pinedo-Villanueva; James Raftery; Paul Glasziou; Mark Mullee Journal: Health Technol Assess Date: 2014-01 Impact factor: 4.014
Authors: Paul Little; Beth Stuart; F D Richard Hobbs; Chris C Butler; Alastair D Hay; Brendan Delaney; John Campbell; Sue Broomfield; Paula Barratt; Kerenza Hood; Hazel Everitt; Mark Mullee; Ian Williamson; David Mant; Michael Moore Journal: Lancet Infect Dis Date: 2014-01-17 Impact factor: 25.071
Authors: Desiderio Passali; Maria Felice Arezzo; Alessandra De Rose; Gianmarco De Simone; Gianluigi Forte; Michalina Jablko-Musial; Ralph Mösges Journal: BMC Prim Care Date: 2022-06-17