›Viral testing per local protocol and infection control needs
›CBC and BMP if toxic, dehydrated, or deep infection concern
›CT neck with IV contrast if deep neck space infection concern
Therapeutic plan for uncomplicated sore throat
›Symptom control
›Acetaminophen PO 1000 mg once
›Maximum 3000 mg per day local protocol dependent
›Lower maximum with chronic liver disease
›Ibuprofen PO 400 mg once
›Avoid with significant renal impairment
›Avoid with active GI bleeding
›Dexamethasone PO or IM 10 mg once local protocol dependent
›Avoid if concern for untreated deep space infection with airway compromise without definitive plan
›Hyperglycemia risk counseling
›Topical anesthetic local protocol dependent
›Viscous lidocaine caution with aspiration risk
›Avoid excessive dosing
Antibiotics when indicated
›GAS treatment options local protocol dependent
›Penicillin V PO 500 mg twice daily for 10 days
›Preferred when no allergy
›Adherence importance
›Amoxicillin PO 500 mg twice daily for 10 days
›Avoid if EBV likely
›Rash risk with EBV
›Cephalexin PO 500 mg twice daily for 10 days
›Avoid in immediate anaphylaxis type penicillin allergy
›Alternative for non anaphylactic reactions
›Azithromycin PO 500 mg day 1
›Then 250 mg daily days 2 to 5
›Macrolide resistance local protocol dependent
Peritonsillar abscess and deep infection
›Escalation treatment local protocol dependent
›IV antibiotics for deep infection concern
›Ampicillin sulbactam IV 3 g every 6 hours
›If penicillin anaphylaxis, clindamycin IV 600 mg every 8 hours
›Drainage pathway for PTA when stable
›Needle aspiration by trained clinician
›ENT drainage if difficult anatomy or complications
›IV fluids for dehydration
›Balanced crystalloid 20 mL per kg bolus if hypotension
›Reassess after bolus
Reassessment loop
›Time based reassessment
›Recheck airway and voice within 30 to 60 minutes after analgesia
›Recheck PO tolerance after symptom control
›Repeat vitals after fluids or antipyretics
›Escalate imaging and consult if worsening
17Disposition/dispo24
ICU criteria
›ICU needs
›Impending airway compromise
›Stridor at rest
›Respiratory distress requiring high flow oxygen
›Septic shock or persistent hypotension
Inpatient admission criteria
›Admission indications
›Deep neck space infection suspected or confirmed
›Peritonsillar abscess with failed ED drainage or significant comorbidity
›Severe dehydration with inability to tolerate PO
›Immunocompromised with systemic illness
Observation pathway criteria
›Observation fits
›Moderate dehydration improving with IV fluids
›Pain control requiring repeated parenteral dosing
›Awaiting imaging or consultant reassessment
Discharge criteria
›Safe discharge features
›No airway red flags
›Able to swallow liquids
›Vitals stable
›Reliable follow up and return ability
›Clear plan for pending tests local protocol dependent
Follow up timing
›Follow up plan
›Primary care within 24 to 72 hours if persistent symptoms
›ENT within 24 to 48 hours for PTA pathway local protocol dependent
›Return for worsening within 12 to 24 hours if borderline
18Discharge Instructions/di28
Copy discharge instructions
›Summary
›Today you were seen for sore throat
›Your exam and tests suggest a throat infection or irritation without dangerous airway swelling
›Medications
›Acetaminophen as directed on label
›Ibuprofen as directed on label if safe for you
›If antibiotics prescribed, take the full course
›If you develop a rash after starting antibiotics, stop the medication and seek medical advice
›Hydration and diet
›Drink frequent small sips of fluid
›Soft foods as tolerated
›Activity
›Rest until fever resolves
›Avoid sharing drinks or utensils while symptomatic
›Follow up
›Follow up with your clinician in 1 to 3 days if not improving
›Return to emergency care now if
›Trouble breathing
›Noisy breathing
›Drooling or unable to swallow saliva
›Worsening neck swelling
›Severe worsening one sided throat pain
›High fever with feeling very unwell
›New rash with swelling of lips or tongue
›Dehydration signs
›Very low urine output
›Dizziness
›Fainting
19References/r6
Guidelines and key sources
›Evidence base
›Infectious Diseases Society of America guideline for group A streptococcal pharyngitis 2012
›Centers for Disease Control and Prevention clinical guidance for group A strep pharyngitis updated regularly local protocol dependent
›National Institute for Health and Care Excellence sore throat acute antimicrobial prescribing guideline 2018
›American Academy of Pediatrics Red Book streptococcal pharyngitis section updated regularly local protocol dependent
›American Academy of Otolaryngology Head and Neck Surgery guidance on peritonsillar abscess management local protocol dependent
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.