Acute, predominantly viral infection of nose, throat, sinuses, or larynx. Self-limiting in most adults; antibiotics rarely indicated.
⚠ Red flags
- High fever >39°C persisting >3 days
- Stridor / drooling / inability to swallow secretions
- Severe unilateral throat pain or trismus (quinsy)
- Immunocompromised patient or severely systemically unwell
Diagnostic criteria
Clinical
- Sore throat, rhinorrhoea, cough, low-grade fever, myalgia
- Onset <14 days, no signs of pneumonia or systemic toxicity
Investigations
- No investigations required for uncomplicated URTI
- Throat swab if Centor ≥3 and bacterial pharyngitis suspected
Scoring tools
- Centor / McIsaac score for streptococcal pharyngitis
- FeverPAIN score (NICE)
Investigations
Optional
- Rapid strep antigen / throat swab if Centor ≥3 or FeverPAIN ≥4
- FBC + CRP if systemically unwell or immunocompromised
- Monospot/EBV serology if persistent tonsillopharyngitis or lymphadenopathy
Management
Acute
- Symptomatic relief; reassure most resolve in 7–10 days
Non-pharmacological
- Adequate hydration and rest
- Saline nasal irrigation
- Throat lozenges / warm fluids
Pharmacological
| Drug | Dose | Notes |
|---|---|---|
| Paracetamol | 1 g PO QDS PRN | First-line antipyretic/analgesic. |
| Ibuprofen | 400 mg PO TDS PRN | Add or alternate if paracetamol insufficient. Caution in renal impairment. |
| Phenoxymethylpenicillin | 500 mg PO QDS for 10 days | Only if confirmed/strongly suspected GAS pharyngitis. |
| Co-amoxiclav | 625 mg PO TDS for 5–7 days | For acute bacterial sinusitis with symptoms >10 days or worsening after initial improvement. |
Monitoring
- Self-monitoring; review only if symptoms worsen or persist beyond 10 days
Referral criteria
- Stridor, drooling, difficulty swallowing — suspect epiglottitis (urgent ENT)
- Peritonsillar abscess (quinsy): unilateral swelling, uvular deviation, trismus
- Recurrent tonsillitis meeting tonsillectomy criteria
Complications
- Acute bacterial sinusitis or otitis media
- Peritonsillar abscess (quinsy)
- Lower respiratory tract infection
- Post-streptococcal sequelae (rare): rheumatic fever, glomerulonephritis
Special populations
- Pregnancy
- Paracetamol preferred; avoid ibuprofen in 3rd trimester. Penicillin V safe.
- Renal impairment
- Caution with NSAIDs; adjust antibiotic doses if eGFR <30.
- Hepatic impairment
- Reduce paracetamol if severe; avoid co-amoxiclav in active liver disease.
- Elderly
- Lower threshold for assessment if frail; pneumonia easily missed.
- Paediatric
- Most viral; do not give aspirin (Reye syndrome). Use weight-based paracetamol/ibuprofen.