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The FeverPAIN score¹ predicts the likelihood of a patient having a streptococcal throat infection. It is used for patients presenting with pharyngitis in primary care to assess the likelihood of a streptococcal infection as opposed to a more common viral cause for the pharyngitis. The FeverPAIN score should NOT be used in children less than 3 years old as this group of patients are much more likely to have viral infections and/or atypical presentations of streptococcal infection.

By identifying the minority of patients with pharyngitis that have sterptococcal infection, clinicians can reduce the inappropriate use of antibiotics in pharyngitis. The authors¹ state that the FeverPAIN score can safely reduce antibiotic use by 30%.

You must give information about all five assessments - fever, cough/coryzal symptoms, onset of symptoms, and the two assessments of the tonsils - in order to determine a FeverPAIN score for this patient.

Fever in the past 24 hours:

yes

no

Absence of cough or coryza:

yes

no

Symptom onset ≤3 days:

yes

no

Purulent tonsils on examination:

yes

no

Severe tonsil inflammation:

yes

no

Antibiotics: Phenoxymethylpenicillin remains first line due to its high effectiveness, no reported resistance, and narrow spectrum of activity. In the event of non-availability, amoxicillin, macrolides and cefalexin are alternative agents in decreasing preference. Antibiotic treatment length for sore throat should follow NICE guidance. For phenoxymethylpenicillin: Five days of phenoxymethylpenicillin may be enough for symptomatic cure, but a 10-day course may increase the chance of microbiological cure