FeverPAIN Score for Strep Throat
UK-derived 5-item clinical score to predict Group A Strep pharyngitis and guide antibiotic prescribing. Validated in UK primary care. Endorsed by NICE NG84.
How to use & interpret
FeverPAIN is the sore-throat scoring tool recommended by NICE to support antibiotic stewardship. One point each for: Fever (in the last 24h), Purulence, Attended rapidly (within 3 days of onset), severely Inflamed tonsils, and No cough or coryza.
A score of 0–1 makes streptococcal infection unlikely and antibiotics are not advised; 2–3 may justify a delayed (backup) prescription or testing; 4–5 suggests considering an immediate or backup antibiotic. It complements clinical judgement and should be paired with safety-netting advice.
Score interpretation
FeverPAIN 0–1: Low probability of GAS (~18%). Antibiotic not recommended.
→ No antibiotic. Symptomatic treatment: regular paracetamol and/or ibuprofen. Adequate hydration. Safety-net: return if not improving after 1 week or if symptoms significantly worsen.
FeverPAIN 2–3: Intermediate probability (~38–60%). Delayed antibiotic strategy.
→ Delayed prescription strategy (NICE NG84): give prescription but instruct patient to wait 2–3 days — use only if not improving. Phenoxymethylpenicillin 500mg QDS × 10 days if started. Advise on avoiding spread.
FeverPAIN 4–5: High probability of GAS (~73–80%). Immediate antibiotic recommended.
→ Phenoxymethylpenicillin 500mg QDS × 10 days (first-line). Amoxicillin 500mg TDS × 10 days (alternative — do NOT use if glandular fever / EBV suspected). Allergy: clarithromycin 250mg BD × 5 days. Advise completing full course.
Interpretation bands for the FeverPAIN. Apply clinical judgement and local guidance.
Frequently asked questions
FeverPAIN or Centor?
Both are validated; NICE (NG84) references FeverPAIN, which was derived in UK primary care and tends to recommend fewer antibiotics. Use one consistently per local guidance.
References
- Little P et al. Validating the FeverPAIN score for streptococcal pharyngitis in primary care. Ann Fam Med. 2013.
- NICE NG84. Sore throat (acute): antimicrobial prescribing. 2018.
Related
Curated clinical cross-links plus same-class fallbacks.
- Phenoxymethylpenicillin (Penicillin V) · Antibiotic — Tonsillitis / Pharyngitis
- Doxycycline 100mg (Acne / Rosacea) · Oral tetracycline antibiotic (anti-acne / anti-rosacea)
- Lymecycline 408mg (Acne) · Oral tetracycline antibiotic (anti-acne)
- Erythromycin 2% Topical · Topical macrolide antibiotic (anti-acne)
- Mupirocin 2% Ointment · Topical antibiotic (pseudomonic acid)
- Fusidic Acid 2% Cream · Topical antibiotic (steroidal antibiotic)
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.