Centor Score for Strep Pharyngitis
Estimates probability of Group A Streptococcal pharyngitis to guide testing and antibiotic use (derived in adults; Centor 1981).
How to use & interpret
The Centor score (and the age-adjusted McIsaac modification) estimates the likelihood that a sore throat is due to group A streptococcus, to target testing and antibiotics. Points are given for tonsillar exudate, tender anterior cervical nodes, fever, and absence of cough (McIsaac adjusts for age).
Low scores make strep unlikely and support no antibiotic; higher scores raise the probability and may justify testing or, depending on local policy, empirical antibiotics. In UK primary care the FeverPAIN score is an alternative recommended by NICE. Both are guides to support antibiotic stewardship, not a substitute for clinical assessment.
Score interpretation
Centor 0–1: probability of GAS 2.5–6.5% (Centor 1981).
→ No antibiotic; self-care and safety-netting advice (NICE NG84).
Centor 2–3: probability of GAS 15–32%.
→ Centor 2: no antibiotic. Centor 3: consider an immediate or back-up antibiotic prescription (NICE NG84).
Centor 4: probability of GAS 56%.
→ Empirical antibiotic treatment (adults: penicillin V or amoxicillin 500mg TDS 10 days) or test and treat. Children: use a children's formulary.
Interpretation bands for the Centor. Apply clinical judgement and local guidance.
Frequently asked questions
Centor or FeverPAIN?
Both are validated; NICE NG84 references FeverPAIN and Centor. FeverPAIN was derived in UK primary care and tends to recommend fewer antibiotics. Use whichever your local guidance specifies, consistently.
References
- Centor RM, et al. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239–46.
Related
Curated clinical cross-links plus same-class fallbacks.
- Phenoxymethylpenicillin (Penicillin V) · Antibiotic — Tonsillitis / Pharyngitis
- Flucloxacillin (Burns — Wound Infection) · Antibiotic — Penicillinase-Resistant Penicillin
- Colistin (Polymyxin E — XDR Burns Infection) · Antibiotic — Polymyxin (Last-Resort)
- Tobramycin Inhalation · Inhaled Antibiotics — Bronchiectasis & Cystic Fibrosis
- Colistimethate Sodium (Inhaled) · Inhaled Antibiotics — Bronchiectasis & Cystic Fibrosis
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
