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: streptococci isolated in 13–18% (Little 2013). NICE NG84: do not offer an antibiotic.
→ 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: streptococci isolated in about 30–48%. NICE NG84: consider no antibiotic or a back-up antibiotic prescription.
→ No antibiotic with advice, or a back-up prescription (NICE NG84) to use only if symptoms do not start to improve within 3–5 days or worsen rapidly. Adults: phenoxymethylpenicillin 500mg QDS × 10 days if started. Advise on avoiding spread. Children: use a children's formulary.
FeverPAIN 4–5: streptococci isolated in 62–65%. NICE NG84: consider an immediate antibiotic or a back-up antibiotic prescription.
→ Adults: 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. Children: use a children's formulary.
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, Moore M, Hobbs FDR, et al. PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A β-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat. BMJ Open. 2013;3(10):e003943.
- Little P, Hobbs FDR, Moore M, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ. 2013;347:f5806.
- 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.