published in Huisarts Nu 1999; 28 (5); 193-201

• Acute sore throat is a common complaint in general practice (3% of all "reasons for encounter").
  In less than one-third of cases is it a streptococcal infection. With present-day resources it is not possible to distinguish streptococcal infections quickly from other throat infections: clinical examination is unreliable and the sensitivity of the quick strep test is too low.

• Only in the case of streptococcal infections has it been demonstrated that antibiotics – started within three days following the onset of symptoms – can reduce the length of the illness by one to two days.

• It is bit useful no purpose is served in western countries by starting antibiotics to prevent acute rheumatism or acute post-streptococcal glomerulonephritis; the prevention of local complications by antibiotics is also minimal.

• It is possible to examine by history-taking and clinical examination whether other pathological conditions are present (e.g. mononucleosis, peritonsillar abscess etc.), or whether the patient belongs to a risk group (cardiac insufficiency, valve disease, asthma etc.). In the latter case it is appropriate to start antibiotics. Penicillin is still the first-line antibiotic.

• If history-taking and clinical examination demonstrate that no other pathological condition is present and that the patient does not belong to a risk group, it is recommended that the patient should be thoroughly informed about the possible advantages and drawbacks of antibiotic treatment: on the basis of this information the patient can eventually decide for himself which treatment to choose.

• Paracetamol is the preferred treatment for pain relief.