Strep throat: which sore throats need antibiotics

What it is, in plain words

A sore throat is usually viral and settles by itself. In a minority, group A streptococcus is responsible. That matters because antibiotics shorten symptoms slightly, reduce spread and, importantly, prevent rheumatic fever and its damage to heart valves.

Signs to look out for

• Sudden severe sore throat and pain on swallowing
• Fever above 38 C with no cough and no runny nose
• Swollen tender glands in the neck
• White or yellow patches on red, swollen tonsils
• Headache, abdominal pain and vomiting, especially in children

Why it happens

It spreads by droplets and close contact, mainly in children aged 5 to 15 and in households and classrooms. Cough, hoarseness, runny nose and conjunctivitis point strongly to a virus instead.

How doctors confirm it

Clinical scores combine fever, absence of cough, tender neck glands, tonsillar exudate and age. A rapid antigen test on a throat swab gives an answer in minutes and prevents unnecessary prescriptions; culture confirms doubtful cases.

Treatments and solutions

• Penicillin or amoxicillin for ten days when the test is positive, and a macrolide in true penicillin allergy
• Paracetamol or ibuprofen for pain and fever, which help more than most people expect
• Cold drinks, ice lollies and adequate hydration; honey for older children and adults
• No antibiotics for negative tests, whatever the appearance of the tonsils
• Consideration of tonsillectomy only after repeated, well-documented episodes over one to two years

Living with it day to day

You stop being contagious about 24 hours after starting antibiotics, but finish the full ten days: stopping early is what allows rheumatic complications.

When to seek medical help

Seek urgent care for drooling, difficulty opening the mouth, muffled voice, one-sided severe swelling, difficulty breathing, or dehydration.

This article explains general health information in simple language. It does not replace advice from your own doctor.