Management of Fever and Throat Pain

Initial Assessment and Risk Stratification

The American Academy of Family Physicians recommends applying the Centor criteria to determine the likelihood of bacterial pharyngitis, which includes fever by history, tonsillar exudates, tender anterior cervical adenopathy, and absence of cough 1, 4, 5, 6
Patients with 0-2 Centor criteria are likely to have a viral etiology, and antibiotics are not indicated 1, 4
Patients with 3-4 Centor criteria should be considered for rapid antigen detection test (RADT) for Group A Streptococcus, and if positive, antibiotics may be considered but modest benefits must be weighed against side effects, antibiotic resistance, and costs 1, 4

The American College of Physicians recommends ibuprofen or paracetamol (acetaminophen) as first-line treatments for symptomatic relief of acute fever with throat pain, with ibuprofen showing slightly superior efficacy for pain control 1, 2, 3
Ibuprofen is preferred over paracetamol due to its more effective pain relief after 2 hours of administration, superior antipyretic efficacy, and longer duration of action 2, 3
Paracetamol (acetaminophen) is an acceptable alternative, with equivalent efficacy to ibuprofen in many studies and a comparable safety profile when used at recommended doses 1, 2, 5

The Infectious Diseases Society of America recommends that antibiotics should not be prescribed for patients with 0-2 Centor criteria, viral pharyngitis, or prevention of suppurative complications in low-risk patients 1, 4, 6
If antibiotics are indicated (confirmed Group A Streptococcus with 3-4 Centor criteria), penicillin V is the first choice, with alternative options for penicillin-allergic patients including first-generation cephalosporin, clindamycin, or clarithromycin 1, 4, 5, 7

The American Academy of Otolaryngology-Head and Neck Surgery recommends that without antibiotics, acute sore throat typically peaks within 3 days and resolves within 7-14 days, and symptomatic treatment with ibuprofen or paracetamol addresses fever and pain while the illness runs its natural course 1, 6