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    FeverPAIN Score for Strep Pharyngitis

    Predicts likelihood of strep throat.
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    Why Use

    Patients with pharyngitis in primary care settings.

    • The FeverPAIN Score for Strep Pharyngitis was developed to try to help assess which patients with pharyngitis have streptococcal pharyngitis.
    • It was developed in the setting of rapid antigen detection tests for multiple streptococcal strains.
    • While it should be further validated, it appeared to have better utility than the Centor Criteria at lower levels to detect patients who could forgo antibiotic treatment.

    Identifying the minority of pharyngitis patients with streptococcal infection can help providers reduce inappropriate antibiotic use in pharyngitis.

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    Next Steps
    Evidence
    Creator Insights

    Advice

    A low FeverPAIN Score may suggest streptococcal infection is unlikely.

    Management

    The author group that derived the FeverPAIN Score has performed an implementation study suggesting it can safely reduce antibiotic use by 30%.

    Critical Actions

    The FeverPAIN Score requires close examination of the pharynx and precise history taking.

    Facts & Figures

    Score interpretation:

    • A score of 0-1 is associated with 13-18% isolation of streptococcus (close to background carriage rates).
      • No antibiotics recommended.
    • A score of 2 is associated with 30-35% isolation of streptococcus.
      • Delayed antibiotic may be appropriate.
    • A score of 3 is associated with 39-48% isolation of streptococcus.
      • Delayed antibiotic may be appropriate.
    • A score of 4 or more is associated with 62-65% isolation of streptococcus.
      • Consider antibiotics if symptoms are severe or a short delayed prescribing strategy may be appropriate (48 hours).
    Dr. Paul Little

    About the Creator

    Paul Little, MD, MBBS, is a clinical professor and practicing general clinician at the University of Southampton, UK. He was the first general practitioner to be awarded a Wellcome HSR training fellowship, and the first to be awarded an MRC Clinician Scientist Fellowship. His two main areas of research are health promotion and the management of common self-limiting illnesses.

    To view Dr. Paul Little's publications, visit PubMed