Key information from patient history

Age: Streptococcal (bacterial) throat infections are more likely in children of school age. In the NHS England Pharmacy First service, the age cut-off for clinical assessment by a pharmacist is five years. Younger children who are ill with a suspected throat infection need to be seen in general practice.

Duration: Most sore throats will be better within seven days. If present for longer and not resolving, the patient should be referred to their GP for further advice.

Associated symptoms:

• Cold, catarrh and cough may be associated with a sore throat. There may also be a fever present, and general aches and pains. These are generally in keeping with a minor self-limiting viral infection
• Hoarseness of longer than three weeks’ duration is an indications for referral – see later
• Difficulty swallowing (dysphagia) is sometimes seen with tonsillitis or peritonsillar abscess (quinsy) and is a sign usually requiring urgent referral – see later
• Loss of taste or smell (or alteration in these) is a recognised feature of Covid-19, which can also cause sore throat. If this is suspected the patient should do a Covid test.

Previous history: Recurrent bouts of throat infection mean that referral is indicated

Smoking habit: Smoking will tend to exacerbate a sore throat. If the patient smokes, it can be a good opportunity to offer advice and information about quitting.

Present medication:

• Steroid inhalers can cause hoarseness and also candidal infections of the throat and mouth. Generally this happens at high doses and can be prevented by rinsing the mouth with water after using the inhaler. Poor inhaler technique can lead to large amounts of the inhaled drug being deposited at the back of the throat
• Any patient taking carbimazole and presenting with a sore throat should be referred immediately. A rare side-effect of carbimazole is agranulocytosis (suppression of white cell production in the bone marrow)
• The same principle applies to other drugs associated with agranulocytosis, including methotrexate and azathioprine
• A patient receiving chemotherapy for cancer should be referred as a sore throat can be the
  first sign of a life-threatening infection.