Acute sore throat (pharyngitis, tonsillitis, and laryngitis) in children

These guidelines are based on the guidelines found on the Prodigy web site.


Acute sore throat is usually due to a viral infection, often as part of an upper respiratory tract infection / flu-like illness, or due to Epstein-Barr Virus (e.g. in glandular fever).

Group A beta-haemolytic streptococcus (GABHS) is the most common bacterial cause of sore throat. GABHS can be isolated from up to 30% of patients presenting with acute sore throat. However, figures for asymptomatic carriage range from 6% to 40%.

Complications of acute streptococcal sore throat


Viral and bacterial sore throat are clinically indistingusihable. Streptococcal infection is likely, if a scarlet fever rash is present.

Throat swabs and rapid antigen tests should not be carried out routinely in sore throat. Streptococcal serology can identify whether a person has recently been infected with streptococcus, and may be useful for people who remain unwell or develop complications.


Antibiotics are recommended in the following situations:

Scarlet fever

Scarlet fever rash
Scarlet fever rash

Diagnosis is clinical. Throat swabs are usually "positive", although remember they can also be positive in individuals with other rashes that aren't scarlet fever, but who are strep carriers.

Ddx sore throat

Content by Dr. Ian Higginson, Dr. Íomhar O' Sullivan 08/06/2005. Reviewed by Dr. ÍOS 15/01/2007, Dr. Chris Luke Dr. ÍOS 08/01/2010. Last review Dr. ÍOS 14/02/14.