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📋 Reference sheet · Chest, throat and sinuses

Sore throat, ear and sinuses: antibiotic, back-up, or none

Sore throat, earache or blocked sinuses. Score it, then no antibiotic, a back-up, or now.

One page, every threshold with its number and unit. Written and reviewed by practising UK GPs. Last reviewed 29 Jul 2026.

Sore throat, ear and sinuses: antibiotic, back-up, or none An antibiotic decision sheet for acute sore throat, acute otitis media and acute sinusitis in primary care: how long each illness normally lasts, the FeverPAIN and Centor criteria set out in full, the complications that mean same-day referral, who gets an immediate prescription whatever the score, a three way branch by site into no antibiotic, a back-up prescription or an immediate one, when the patient should start a back-up, and the first line drug, dose and course with the penicillin allergy and pregnancy alternatives. Sore throat, earache or blocked sinuses: does this need an antibiotic? All three usually settle alone. Doses are adult unless stated The numbers: how long it lasts, and how the scores run Sore throat about 7 days, better without an antibiotic in most Ear infection about 3 days, up to 7 days Sinusitis 2 to 3 weeks. Fever means > 38 °C FeverPAIN, 1 each fever 24 h · pus · attends in 3 days · inflamed tonsils · no cough Centor, 1 each exudate · tender neck nodes · fever · no cough Centor 0 to 2 reads as FeverPAIN 0 or 1. Centor 3 or 4 reads as 4 or 5. Your local formulary takes precedence over any choice here. Refer to hospital the same day · Stridor, drooling, or cannot swallow saliva · Quinsy: trismus with the uvula pushed over · Swelling or tenderness behind the ear · Eye swelling, double vision, or new confusion Admit today Emergency assessment Immediate antibiotic, whatever the score · Systemically very unwell · Signs of a more serious illness · High risk of complications · Sinuses: Co-amoxiclav 500/125 mg three times a day Prescribe now Not a back-up Say when to return Everyone else: which site are you treating? Paracetamol or Ibuprofen is the main treatment in all three Throat: FeverPAIN 0 or 1: no antibiotic 2 or 3: back-up prescription 4 or 5: immediate or back-up Ear: 3 days is usual None, or a back-up Ear discharge: consider now Under 2 and both ears: same Sinuses: the 10-day line < 10 days: no antibiotic ≥ 10 days: back-up Nasal steroid, 12 and over The back-up prescription: say when to start it · Throat: not improving in 3 to 5 days · Ear: not improving in 3 days · Sinuses: not improving in 7 days · Or worsening rapidly at any time When you do prescribe: first line and course Throat, 18+ Phenoxymethylpenicillin 500 mg four times a day 5 to 10 days Ear, 5 to 17 Amoxicillin 500 mg three times a day 5 to 7 days Sinuses, 18+ Phenoxymethylpenicillin 500 mg four times a day 5 days Children: dose by age or weight, see BNFC First line as published. Your local formulary may differ and takes precedence. Penicillin allergy: swap the drug, keep the course · Throat: Clarithromycin 250 to 500 mg twice a day, 5 days · Sinuses: Doxycycline 200 mg, then 100 mg daily, 5 days · Ear, 12 to 17: Clarithromycin 250 to 500 mg twice a day, 5 to 7 days · Pregnancy: Erythromycin 250 to 500 mg four times a day, 5 days Two that catch people out · A score guides the antibiotic, it does not make the diagnosis · Antibiotics shorten a sore throat by about 16 hours BNFC: British National Formulary for Children Education, not advice. Your local formulary takes precedence. GPAtlas · NICE NG84 · NICE NG91 · NICE NG79

Related Ocean Article: Sore Throat · also Otitis Media (OM) - Acute, Sinusitis. Part of the GP reference sheets, result interpretation one page per test or finding.

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