When you need antibiotic for sore throat ? (Centor criteria ) simple evidence based method.
Feeling irritated, soar throat, generalized fatigability and strange taste in your mouth , you feel sick but not that much sick to stay in bed all day or take sick leave from work, it awful feeling like a splinter in your throat driving you mad, you are irritable and get angry easily . Did you had this before? if you do am sure you tried everything to make it go away as soon as possible. is this blog i will try to help you to make the right decision if you need Antibiotic or you need just to relax, avoid cold drink and drink some tea or hot soup and maybe get over counter symptomatic treatment.
most etiology of upper respiratory tract infection is viral in origin and does't need antibiotic. it vary between young and old but overall viral infection is the wiener who annoying us every now and then specially in winter.
upper respiratory tract contain : nasal cavity, pharyngx and laryngx. we will focus in pharynx infection (pharyngitis) in this blog. Pharyngitis is inflammation \ infection of the pharynx or tonsils.
The most common virus causing sore throat is Rhinoviruses ,it's responsible of approximately 50% of colds in adults; they grow optimally at nasal cavity inside the human nares, perfect environment including temperature for this virus, like walking in a beach in summer day.
There is more than 200 type of viruses common to cause cold or sore throat like Coronaviruses, Enteroviruses, Adenoviruses and the list goes on and on.
most viral infection don't need antibiotic with some few exception, i won't confuse you with unnecessary information, let.s get to the point.
Unlike viral infection which is usually self limited Bacterial infection need treatment most of the time, the most common bacterial cause of sore throat and tonsillitis is Group A streptococci, it is nasty and won't just go way easily
in the rest of this blog i will present the easiest evidence based method to diagnose bacterial pharyngitis.
When i need antibiotic for my sore throat ?
Centor criteria is a set of question and each have a score, determined in the end based on calculated score how are likely you have bacterial pharyngitis.
It used mainly in Emergency department and primary health center but i think it can give an educated person a clue if he need to seek medical advice immediately, it is simple, reliable and easy to use .
only 4 question, each one have score of 1
1- cough. 2- Fever. 2-Tonsillitis exudation. 4-Tender Anterior cervical adenopathy
1 - No cough
Cough usually indicate Lower respiratory tract infection
2 - Fever >38.0 °C (100.4 °F)
generally viral infection cause low grade fever, high grade fever make bacterial infection more likely
3 - Tonsillitis exudation
some time it difficult to assess by your self & need health care worker because you need for proper examination a tong depressor and torch to expose oral cavity, uvula and tonsils.
how streptococcal pharyngitis looks like? click here
4 - Tender anterior cervical Adenopathy
lymph nodes tenderness and enlargement enlargement in the front part of the neck.
calculate the score
1 - if you or person who you checked have score of (0 to 1) most likely nonbacterial and NO NEED FOR ANTIBIOTIC
2 - if the score is (1-3) Antibiotic is needed and it is prefer to visit a doctor
3 - if the score is (4) go to see a doctor NOW
NB : modified Centor criteria added age,, the idea here that young age 3-14 are more vulnerable to step-pharyngiti so you get (+1) for being >14 and (-1) for being >45 and (0) in between
What you should expect doctor to do ?
He will do a rapid strep test to confirm the diagnosis and start antibiotic or h\she will take a sample for culture and start antibiotics while result is pending, if the result confirm step-pharyngitis you should complete the treatment and if it atypical result antibiotic may changed.
Treatment
Antibiotics
No matter how much medical knowledge you have Antibiotics should be prescribe only by your doctor, specially if you have chronic medical condition like Diabetic, Hypertension, Bronchial Asthma and taking already regular medication moreover to get the right antibiotic and proper dose for certain time.
Symptomatic treatment (to relieve congestion, fever and pain)
most are over-counter medication, just try to read carefully side effects before use one, for example some Antihistamine cause sedation and sleepiness, if you toke that before work or driving for a distant you might get serious trouble so it is better to take it at bed time.
disclaimer : please don't abuse this, it is not a tool to self diagnosis, it is a tool to alarm you or other you examined if seeing doctor is needed now.
links for references & if you wish to read more
uptodate.com/contents/search?search=Viral%20Pharyngitis
uptodate.com/contents/group-a-streptococcal-tonsillopharyngitis
emedicine.medscape.com
mdcalc.com/centor-score-modified-mcisaac-strep-pharyngitis
nhs.uk/conditions/Respiratory-tract-infection/Pages/Introduction.aspx
Great criteria. It's saved me on more than a few that actually had strep throat. Love that criteria. Great informative post! It prevents the overuse of antibiotics but also lets you diagnose it when in doubt. Had one case where I doubted strep throat. No exudates and throat was not very red. But history of fever (no clinical fever), sore throat, and no cough. Decided to test it and have a little faith in CENTOR. Glad I did! Opposite is true. Might have a red throat but if there is a cough and no fever likely not!
Met too, easy way to decide if you will hit with Abx or not, agree with last point, i had same experience before
It is also important to relies that viral infection can exhaust immune system so Bacteria can kick in easily, in that case Staphylococcus aureusis the most superimpose infection post viral in respiratory tract, am not a fan of Antibiotics but if my symptom not improved in 2 days i add Abx.
Thank you for showing up @tfeldman
Good point in the outpatient setting sometimes docs will give an antibiotic script and tell the parent not to fill the prescription unless the child is sick for 2 more days (really good for ear infections)
Good post! Thanks for sharing those pieces of advice!
It means a lot coming from Particle physicist and professor in physics, Thank you @lemouth, i am following you know, looking forward to read your next blogs
thnx again
I will try to find some time to write. My real life is (very)1000 demanding those days ;)
Taste in your mouth not test.
cheers
Thank you @justtryme90, edited :)
glad that you showed up
I glanced it over, I'll try to read in more detail later. Ill let you know if I notice something else @araki.
Cheers!
Yes pleas that will be helpful
thnx again
Cheers
I read it in detail. Good post. You have some issues with appropriate punctuation (like you have spaces between words and commas, and you don't capitalize the first letter of the first word in a sentence a bunch of times). When you are talking about yourself and using the pronoun I, it is always capitalized.
Thank you @husttryme90, i will follow your advice in future blog, I always have a problem with formal writing specially with punctuation. I will be grateful if you help me improve my writing, please comment in any mistake.
Thnx again for reading my blog, appreciate the kind help and as you always say CHEERS