This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Most sore throats are caused by viruses and get better on their own within a week. Only about a quarter to a third of adults and children seen for a sore throat have group A streptococcus, the bacterium that antibiotics can treat. The FeverPAIN score was developed in England by Paul Little and colleagues in 2013 to help decide who might benefit from an antibiotic, and it is recommended by NICE in the UK.
The five items
Each item scores 1 point, and the name is a reminder of them:
| Letter | Item |
|---|---|
| Fever | fever in the last 24 hours |
| Purulence | pus on the tonsils |
| Attend rapidly | symptoms for 3 days or less before the visit |
| Inflamed tonsils | severely inflamed tonsils |
| No cough or coryza | no cough and no runny or blocked nose |
Example
A teenager who had a fever last night, has had a sore throat for two days and has no cough or cold scores 3: an intermediate result, with strep found in roughly a third of similar patients.
What the score means
| Score | Strep in the derivation study | Suggested approach |
|---|---|---|
| 0 to 1 | 13 to 18% | no antibiotic |
| 2 to 3 | 34 to 40% | no antibiotic, or a delayed prescription to use only if things get worse |
| 4 to 5 | 62 to 65% | an immediate antibiotic or a delayed prescription can be considered |
In the original trial, using the score cut antibiotic prescribing by about a third while patients felt better slightly faster.
FeverPAIN or Centor?
The Centor score (and the McIsaac version, which adds age) is used more in North America and in France, often together with a rapid strep test in the office. FeverPAIN was designed for primary care where testing is not routine. Both help identify who is unlikely to have strep.
When to seek care quickly
Whatever the score, see a doctor urgently for trouble breathing or swallowing saliva, drooling, a muffled voice, a swelling on one side of the throat, a stiff neck, a rash, or if you feel very unwell. Painkillers such as paracetamol or ibuprofen relieve the pain in all cases.