2.1 Incidence of Sore Throat in General Practice

Most patients with sore throat never attend their general practitioner (GP).⁶ A 1975 UK study of 516 women aged 20-44 years, found that only one in 18 episodes of sore throat led to a GP consultation.⁷

The overall incidence of sore throat in all age groups has been estimated variously at 500 cases per general practitioner per year according to 1978 figures,⁶ 100 per 1,000 people per year⁸ or 45 per 1,000 consultations in New Zealand.⁴ Estimates of consultation rates (per capita per annum) for sore throat also vary: 0.08-0.20 in single practices, 0.2 in a region, and in the possibly atypical practices in the national morbidity survey, approximately 0.1 (assuming 1 in 4 `respiratory' attendances are for sore throat and allowing for re-attendance).⁹ Different definitions make comparisons between figures difficult. The age distribution and management of sore throat which is reported to a GP varies widely across Europe.¹⁰

Using the conservative figure of 0.1 consultations per capita per annum along with UK population estimates, and assuming that a consultation costs £10, then the cost to the NHS of GP consultations for sore throat is approximately £60 million per annum, before any treatment or investigation.⁹

2.2 Reasons for presentation in general practice

A 1994 Dutch study of 1441 children attending general practice estimated 223 new episodes of tonsillitis per 1000 subjects per year during the first five years of life, with no difference between sexes or social classes. The observed distribution was not random: more children than expected had no episodes, and significantly more children than expected had high numbers of episodes (>11 episodes). Factor analysis showed that sore throat, otitis media and common cold were inter-related, but the authors point out that `illness behaviour' may partly influence the tendency to seek care for less serious diseases.¹¹

In common with many familiar conditions encountered in general practice, presentation with sore throat may be the introductory topic to a wider agenda for the patient. The complex interplay between the patient, the doctor, psychosocial factors and the acute illness is relevant to the reason for the consultation and may have a fundamental influence upon decisions made.^12-14 Recent evidence suggests that antibiotic prescribing for sore throat in general practice enhances patient belief in antibiotics and increases intention to consult for future episodes.¹⁵ Evidence level IIa

Practitioners should be aware of underlying psychosocial influences in patients presenting with sore throat.

A patient information leaflet may be of value in the management of acute sore throat and may assist in managing future episodes at home without general practitioner involvement (see example at Annex 2).

2.3 Emergency hospital admission

Hospital admission will be required for few patients with sore throat. When such patients present acutely to an ENT service they usually have peritonsillar cellulitis or abscess and may require parenteral antibiotics. The complication of parapharyngeal abscess is now rare. In young adults, infectious mononucleosis is a common reason for hospital admission as these patients are often unable to swallow. The occasional patient with severe uncomplicated tonsillitis may require admission because of dysphagia and dehydration.

Sore throat associated with stridor or respiratory difficulty is an absolute indication for admission to hospital.