Introduction

Sore throat is one of the commonest presentations in primary care and community pharmacy teams have been advising effectively on the condition for many years.  Drawing on the NICE Sore throat (acute): antimicrobial prescribing guideline [NG84] and CKS Sore Throat, this toolkit will support your decision-making regarding the provision of self-care advice, OTC medicines, the small number of occasions when a sore throat might benefit from antibiotics, and when referral is needed.

Around 90 per cent of sore throats that present in the pharmacy will be caused by viral infection. Clinically, it is difficult to differentiate viral and bacterial infections and the majority of both are self-limiting.

As such, it may be easy to ascribe all sore throats to viral causes. It is important, therefore, to keep an open mind for each patient who presents with a sore throat or upper respiratory tract symptoms. A good history and a comprehensive examination should allow for a confident diagnosis.

Clinical pathway

Use the clinical pathway for sore throat to help guide your diagnosis. Be alert for anyone with systemic illness or signs of sepsis, breathing difficulties or stridor, suspected epiglottitis or diphtheria, those who appear to be dehydrated, or where a pharyngeal abscess is suspected. Refer such patients urgently to A&E for further assessment or call 999.

In the UK, sore throats are one of the main reasons for prescribing antibiotics but even where there is bacterial infection, antibiotics make little difference to outcome, and are unnecessary in most cases. Check for possible differential diagnoses such as scarlet fever, quinsy, glandular fever or suspected cancer. An urgent GP referral may be necessary.

Patients who are immunosuppressed or taking medicines known to cause agranulocytosis (e.g. methotrexate, sulfasalazine, carbimazole, propylthiouracil, cotrimoxazole, valganciclovir, clozapine, carbamazepine, all chemotherapy) should also be referred to their GP.