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  Clinical Calculators - FeverPAIN  
     
 

The FeverPAIN score1 predicts the likelihood of a patient having a streptococcal throat infection. It is used for patients presenting with pharyngitis in primary care to assess the likelihood of a streptococcal infection as opposed to a more common viral cause for the pharyngitis. The FeverPAIN score should NOT be used in children less than 3 years old as this group of patients are much more likely to have viral infections and/or atypical presentations of streptococcal infection.

By identifying the minority of patients with pharyngitis that have sterptococcal infection, clinicians can reduce the inappropriate use of antibiotics in pharyngitis. The authors1 state that the FeverPAIN score can safely reduce antibiotic use by 30%.

You must give information about all five assessments - fever, cough/coryzal symptoms, onset of symptoms, and the two assessments of the tonsils - in order to determine a FeverPAIN score for this patient.

  Fever in the past 24 hours:      
    yes  
    no  
         
  Absence of cough or coryza:      
    yes  
    no  
         
  Symptom onset ≤3 days:      
    yes  
    no  
         
  Purulent tonsils on examination:      
    yes  
    no  
         
  Severe tonsil inflammation:      
    yes  
    no  
         
         
       
         

 
     
 

Antibiotics: Phenoxymethylpenicillin remains first line due to its high effectiveness, no reported resistance, and narrow spectrum of activity. In the event of non-availability, amoxicillin, macrolides and cefalexin are alternative agents in decreasing preference. Antibiotic treatment length for sore throat should follow NICE guidance. For phenoxymethylpenicillin: Five days of phenoxymethylpenicillin may be enough for symptomatic cure, but a 10-day course may increase the chance of microbiological cure

See also the Centor Criteria

DECEMBER 2022 UPDATE: Given the current high prevalence of group A Streptococcus (GAS) and an increase in invasive groups A Streptococcus (iGAS), a decision to treat tonsillitis with antibiotics in CHILDREN over 3 years old can be guided by a FeverPAIN score of 3 or more (this is a lower threshold in light of increased invasive Group A Streptococcus incidence and deviates from NICE Guidelines) in combination with clinical judgement.

This updated guidance is valid until end of January 2023 when it will be reviewed. For more information see Group A streptococcus in children - Interim clinical guidance summary

 
     
 

References:

  1. Little P, Hobbs FD, Moore M, Mant D, Williamson I, McNulty C, Cheng YE, Leydon G, McManus R, Kelly J, Barnett J, Glasziou P, Mullee M; PRISM investigators. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ. 2013 Oct 10;347:f5806. doi: 10.1136/bmj.f5806. Erratum in: BMJ. 2018 Mar 5;360:k1068. PMID: 24114306; PMCID: PMC3805475.
 
     
   
   
   
 

 

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