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FeverPAIN score calculator
Five criteria that estimate the likelihood of streptococcal sore throat and guide whether an antibiotic, a delayed prescription, or neither is appropriate.
Open the interactive calculator
Opens the FeverPAIN Score card in the ResusDoc Clinical Scores app — scores as you tap, with the interpretation and next steps.
What it is used for
FeverPAIN is the score NICE NG84 recommends for acute sore throat in the UK, in adults and children. Each of the five criteria scores 1, and the total maps onto the probability of streptococcal infection and a corresponding antibiotic recommendation. The purpose is antimicrobial stewardship: most sore throats are self-limiting, and FeverPAIN identifies the minority in whom an antibiotic is likely to help while supporting a no-antibiotic or back-up prescription strategy in the rest.
The five criteria (1 point each, maximum 5)
| Component | Points |
|---|---|
| Fever in the past 24 hoursAbove 38°C | 1 |
| PurulencePus on the tonsils | 1 |
| Attend rapidlyWithin 3 days of symptom onset | 1 |
| Severely Inflamed tonsils | 1 |
| No cough or coryza | 1 |
How the score is interpreted
0–1
Low likelihood
13–18% likelihood of streptococcus. An antibiotic is not recommended. Self-care advice, analgesia with paracetamol or ibuprofen, adequate fluids. Safety-net and review if symptoms worsen or have not settled in about a week.
2–3
Intermediate likelihood
34–40% likelihood. Either no antibiotic, or a back-up (delayed) prescription to start if there is no improvement in 3–5 days. Reassess if rapidly worsening.
4–5
High likelihood
62–65% likelihood. Consider an immediate antibiotic — phenoxymethylpenicillin first-line, clarithromycin or erythromycin if penicillin-allergic — or a back-up prescription. Consider admission if the patient is systemically very unwell or there are signs of complication.
When not to use it
- FeverPAIN estimates the likelihood of streptococcus; it does not diagnose it, and it does not exclude a deep space infection.
- It does not replace assessment for quinsy, epiglottitis or airway compromise — trismus, drooling, stridor or a muffled voice need urgent attention regardless of score.
- Apply clinical judgement alongside the score, as NICE NG84 makes explicit.
Source: FeverPAIN · NICE NG84 · acute sore throat
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