How common is sore throat in general practice

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How common is sore throat in general practice?
Total 417, out of 6000 patients 7 or 1 in
14 Estimated total consultations 14000 3 of
consultations
2
Causes of acute sore throat

• Aetiology probability()
• Viral 50-80
• Streptococcal 5-36
• Epstein-Barr virus 1-10
• Chlamydia pneumoniae 2
• Mycoplasma pneumoniae 2-5
• Neisseria gonorrhoeae 1-2
• Haemophylus influenzae 1-2
• Candida lt1
• Diphtheria lt1

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history

• Duration of symptoms
• ? Cough, dysphagia
• ? Fever, malaise
• ? rash

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Examination

• General condition, temperature, pulse
• Any stridor or drooling?
• Throat redness, enlarged tonsils, exudate
• Neck glands
• ? Rash

5
Clinical features of streptococcal throat

• History
• Sore throat
• Fever
• Malaise
• Examination
• beefy red throat
• swollen tonsils
• grey/white exudate on tonsils
• swollen, tender anterior neck glands, at angle of
  jaw
• rash (scarlet fever). Fine red papules,
  sandpaper feel. Pastias lines. Peeling
• strawberrytongue
• circumoral pallor

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Complications of streptococcal throat

• Quinsy
• Otitis media
• Sinusitis
• Scarlet fever
• Glomerulonephritis
• Rheumatic fever

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Glandular fever(infectious mononucleosis)

• Epstein-Barr virus
• Fever, headache,malaise, sore throat
• Palatal petechiae
• Posterior cervical lymph nodes
• Transient rash
• Splenomegaly
• Mild hepatitis
• Diagnosis atypical mononuclear cells,
  heterophile antibodies

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Acute epiglottitis

• Infection of epiglottis by Haemophilus influenza
  B
• Classically children 2-6, now more common in men
  in their 40s.
• rare. Incidence1 in 100,000 in USA
• Septic, ill, quiet, terrified
• Dysphagia
• Quack-like cough
• Drooling
• Stridor
• Do not examine the throat! Risk of causing
  respiratory arrest!

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Antibiotics for sore throat

• Del Mar CB, Glasziou PP, Spinks AB. Antibiotics
  for sore throat. Cochrane Database of Systematic
  Reviews 2006.

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with sore throat
Days from presentation
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Do antibiotics reduce complications?
Based on data from the 1950s!
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Howie and Foggo 1985Antibiotics, sore throats
and rheumatic fever

• Scottish hospital records 1976-79
• 27 cases of rheumatic fever
• Incidence 0.6/100,000/yr
• 19 of these had had a sore throat
• 9 had received an antibiotic, and 10 had not
• Estimated risk of getting rheumatic fever after a
  streptococcal sore throat
• approx 1 in 35,000, antibiotic or not.

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Centor criteriaRobert M Centor et al 1981

• Tonsillar exudate
• Swollen, tender anterior cervical nodes
• Lack of cough
• History of fever
• All 4 56 probability of strep
• None 2.5 probability of strep

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Antibiotics or not?

• Arguments for antibiotics

• Arguments against

• Quicker resolution of symptoms (av 1 day)
• Reduced rate of complications

• Marginal benefit in self-limiting illness.
  Serious complications rare.
• Risk of adverse effects eg diarrhoea, thrush,
  allergy
• Risk of increasing antibiotic resistance
• Encourages reliance on the doctor

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Which antibiotics?

• Phenoxymethylpenicillin (PenV) 250mg qds for 10
  days
• or, if allergic to penicillin
• Erythromycin 250mg qds for 10 days