Clinical Practice Guideline: Sore Throat

Abstract

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.

Figure

Clinical algorithm on the approach to sore throat GAS, group A streptococci; NSAID, non-steroidal anti-inflammatory drugs

eFigure 1

Flow diagram: update of the source guidelines used for the original version Abbreviations of reasons for exclusion: OS: Other subject OP: Other type of publication OW: Withdrawn OL: Language other than English or German OT: Other time of publication or search (no update/older than 5 years)

eFigure 2

Flow diagram: guideline portal search (see eFigure 1 for abbreviations of the reasons for exclusion)

eFigure 3

Flow diagram: systematic guideline search in Medline via PubMed (see eFigure 1 for abbreviations of the reasons for exclusion)

eFigure 4

Flow diagram: systematic search for review articles in Medline via PubMed and the Cochrane Database of Systematic Reviews The 29 systematic reviews included were summarized in evidence tables. The evidence tables can be found in full in Appendix B of the guideline report. (See eFigure 1 for abbreviations of reasons for exclusion)