Key Takeaways
- Most sore throats — up to 85–90% in adults — are caused by viruses. Antibiotics do nothing for viral pharyngitis.
- Group A Streptococcus (strep throat) accounts for 15–30% of sore throat cases in children and about 5–15% in adults.[1]
- The Centor/McIsaac scoring system helps identify who actually needs a strep test — and who doesn't.[3]
- Penicillin and amoxicillin remain the first-line antibiotics for confirmed strep throat — group A Strep has shown no resistance to penicillin in over 90 years of use.
- A peritonsillar abscess is a surgical emergency. Severe one-sided throat pain, a muffled voice, and difficulty opening the mouth require immediate care.
- Untreated strep carries real risk — rheumatic fever can permanently damage heart valves even after symptoms resolve.
Sore throats send more patients to the doctor's office than almost any other acute complaint. The problem is that most of those visits end with an antibiotic prescription — even when none is needed. Studies have found that antibiotics are prescribed for more than 60% of pharyngitis visits in the United States, yet only 5–15% of adult cases are bacterial.[8] That gap represents a lot of unnecessary treatment.
I want to change how you think about sore throats. Not every throat pain needs a prescription. But some do — urgently. The goal of this guide is to help you tell the difference. I'll walk you through how I evaluate a sore throat in the exam room, from the first symptom description through the testing decision to treatment and prevention.
What Causes a Sore Throat?
Pharyngitis — inflammation of the pharynx (the back of the throat) — has many potential causes. Viruses are responsible for the majority. The list of culprits is longer than most people expect:
Viral Causes (85–90% of adult cases)
- Rhinovirus: The most common cause of sore throats overall, responsible for typical cold symptoms including runny nose and mild throat irritation.
- Adenovirus: Often causes more severe throat inflammation, sometimes with eye redness (pharyngoconjunctival fever).
- Influenza A and B: Throat pain is a common early symptom, usually accompanied by fever, body aches, and fatigue.
- Epstein-Barr virus (EBV / infectious mononucleosis): "Mono" causes severe pharyngitis with enlarged tonsils, fatigue, swollen lymph nodes throughout the body, and sometimes spleen enlargement. Common in adolescents and young adults.
- COVID-19 (SARS-CoV-2): Sore throat is a prominent symptom across most variants, particularly Omicron and its descendants.
- Herpes simplex virus (HSV): Can cause primary pharyngitis, particularly in young adults.
- Parainfluenza, enteroviruses, coronaviruses: All can produce throat inflammation as part of a broader respiratory illness.
Bacterial Causes
- Group A Streptococcus (GAS): The bacterium responsible for strep throat, and the one we test for most often. It causes approximately 15–30% of pharyngitis cases in children and 5–15% in adults.[1]
- Group C and G Streptococcus: Can cause a strep-like illness but are not associated with rheumatic fever risk. Less commonly tested for in routine practice.
- Fusobacterium necrophorum: Worth mentioning in young adults — this anaerobic bacterium can cause severe pharyngitis and, in rare cases, Lemierre syndrome, a dangerous thrombophlebitis of the jugular vein.
- Gonorrhea (Neisseria gonorrhoeae): Pharyngeal gonorrhea is usually asymptomatic but can cause pharyngitis in sexually active individuals, particularly after oral sex.
Non-Infectious Causes
Not all sore throats are infections. Post-nasal drip from allergies, dry air, gastroesophageal reflux (which can irritate the throat overnight), vocal strain, and environmental irritants like smoke or chemicals can all cause significant throat discomfort without any bacteria or virus involved. Taking a moment to consider these possibilities is part of a thorough evaluation.
Viral vs. Bacterial — How to Tell the Difference
No single symptom reliably distinguishes strep from a viral sore throat. What we're really doing when we evaluate pharyngitis is estimating the probability of group A strep — then deciding whether to test based on that estimate.
That said, certain symptom patterns are informative:
| Feature | Suggests Strep (Bacterial) | Suggests Viral |
|---|---|---|
| Cough | Absent | Present |
| Runny nose / congestion | Absent | Present |
| Fever | Often present, typically above 101°F | May be present or absent; usually lower |
| Tonsillar appearance | Swollen, red; often with white patches or pus | Mild redness; vesicles suggest HSV or enteroviruses |
| Lymph nodes | Swollen, tender, anterior cervical (front of neck) | Generalized swelling (especially posterior) suggests mono |
| Hoarseness | Uncommon | Common — strongly suggests viral etiology |
| Mouth sores / ulcers | Absent | Suggest HSV, hand-foot-mouth, or herpangina |
| Rash | Sandpaper rash = scarlet fever (strep complication) | Various viral exanthems possible |
| Petechiae on palate | Sometimes present with strep | Can occur with EBV (mono) |
The presence of cough, runny nose, and hoarseness together strongly points to a viral cause. These are sometimes called "coryza features" — and their presence essentially rules out strep as the primary cause. When I see all three, I don't test. When none of them are present and the patient has fever, swollen lymph nodes, and tonsillar exudates, the probability of strep is high enough that testing makes sense.
The Centor/McIsaac Criteria — When Strep Testing Matters
Rather than testing everyone with a sore throat — which leads to unnecessary antibiotic prescriptions from false positives in low-probability patients — clinical guidelines recommend using a structured scoring system to guide the decision.[1] The Centor score, developed in 1981 and subsequently modified by McIsaac, is the most widely validated tool we have for this purpose.
- Fever (temperature above 100.4°F / 38°C, or history of fever in past 24 hours)
- Tonsillar exudate or swelling (white patches, pus, or significant enlargement)
- Swollen, tender anterior cervical lymph nodes (the nodes at the front of the neck)
- Absence of cough (cough suggests a virus; no cough increases strep probability)
- Age adjustment: Add 1 point if age 3–14 years; no change if 15–44 years; subtract 1 point if age 45 or older
A large-scale validation study involving over 206,000 patients confirmed how well these criteria perform in the real world.[3] Here's what the numbers show:
| McIsaac Score | Probability of GAS | Recommended Action |
|---|---|---|
| 0–1 | ~7–13% | Low risk — no testing needed; treat symptomatically |
| 2–3 | ~21–34% | Intermediate risk — test with rapid strep or culture; treat if positive |
| 4–5 | ~51–69% | High risk — test; some guidelines allow empiric treatment without a positive test at score 4–5 |
Even at a score of 4, there's still a roughly 40% chance the patient does not have strep — which is why the 2025 IDSA guidelines recommend testing even high-risk patients rather than prescribing empirically without confirmation.[1] Testing takes 5–10 minutes and prevents unnecessary antibiotic exposure for patients whose throat pain is viral.
One important exception: certain high-risk patients should be tested regardless of their score. This includes anyone with a household exposure to confirmed GAS, a personal history of rheumatic fever, or signs suggesting a serious complication like a peritonsillar abscess.[1]
Symptoms of Strep Throat vs. Viral Pharyngitis
Strep throat typically comes on quickly — often within hours. One of the phrases I use with patients is: "If you felt fine in the morning and terrible by afternoon, that speed of onset is more consistent with strep than a virus." Viral sore throats more often build gradually over a day or two, alongside cold symptoms.
Classic Strep Throat Presentation
- Rapid onset of moderate to severe throat pain
- Difficulty swallowing (odynophagia)
- Fever, often above 101°F (38.3°C)
- Red, swollen tonsils — often with white or yellow patches of pus
- Petechiae (tiny red spots) on the soft palate
- Tender, swollen lymph nodes at the front of the neck
- Headache and body aches
- Nausea or stomach pain, especially in children
- No cough, no runny nose, no hoarseness
Typical Viral Pharyngitis Presentation
- Gradual onset of throat soreness, often starting as dryness or scratchiness
- Runny nose and nasal congestion
- Cough — often the most prominent symptom
- Hoarse voice
- Low-grade fever or none at all
- Mild throat redness without exudates
- Fatigue and general malaise
Infectious mononucleosis (Epstein-Barr virus) deserves special mention because it can look exactly like severe strep throat — with marked tonsillar enlargement, exudates, fever, and lymphadenopathy. Two clues point toward mono: swollen lymph nodes at the back of the neck (posterior cervical adenopathy) rather than just the front, and profound fatigue that seems disproportionate to the throat findings. Mono matters clinically because patients with EBV infection who receive amoxicillin or ampicillin frequently develop a rash — not a true penicillin allergy, but an immune reaction to the drug in the context of EBV. If mono is suspected, we typically hold beta-lactam antibiotics until the diagnosis is clarified.
Diagnosis — The Rapid Strep Test and Throat Culture
When the clinical picture warrants testing, we have two main options. Understanding how each works helps explain why we sometimes order both.
Rapid Antigen Detection Test (RADT)
This is the standard "rapid strep test" done in most offices, urgent care centers, and pharmacies. A swab of the posterior pharynx and tonsils is tested for group A strep antigens. Results come back in 5–10 minutes.
The rapid test is highly specific — roughly 95–99%. That means a positive result is almost always a true positive; you can start antibiotics right away with confidence. The sensitivity is lower, around 70–90%. A negative rapid test can miss real strep infections, particularly if the swab technique is poor or the test is done very early in the illness course.
Throat Culture
The throat culture remains the gold standard. A swab is sent to a lab where it's plated on culture media and incubated for 24–48 hours. Sensitivity is approximately 90–95%. The cost is a delay — if a patient's rapid test is negative but clinical suspicion remains high (McIsaac score 3–4, household strep exposure), a backup culture helps catch the cases the rapid test missed.[1]
In adults, the 2025 IDSA guidelines do not routinely recommend backup cultures when the rapid test is negative, unless the clinical situation specifically warrants it. In children, where the consequences of missed strep are higher, backup cultures for negative rapid tests are more commonly recommended.
Testing for Mono
If mono is suspected, a heterophile antibody test (Monospot) can be done. A complete blood count showing an elevated white count with many atypical lymphocytes is also supportive. EBV-specific antibodies are the most definitive test but are rarely needed in typical presentations.
Treatment — Antibiotics for Strep Throat
Confirmed group A strep pharyngitis should be treated with antibiotics. Three goals drive this recommendation: reducing symptoms and duration of illness, preventing spread to household contacts, and — most critically — preventing rheumatic fever and other serious complications.[6]
First-Line Antibiotics
Penicillin has been used to treat group A strep for over 70 years, and not a single penicillin-resistant GAS strain has ever been documented. That record is unmatched in infectious disease and is why penicillin and amoxicillin remain the preferred treatments in every major guideline.
| Antibiotic | Typical Regimen (Adults) | Notes |
|---|---|---|
| Amoxicillin | 500 mg twice daily × 10 days or 1,000 mg once daily × 10 days |
Preferred in practice — better palatability, especially for children in liquid form. Once-daily dosing improves completion rates. |
| Penicillin V (oral) | 500 mg twice daily × 10 days | Narrow spectrum — ideal for antibiotic stewardship. Equally effective to amoxicillin. Some prefer this for that reason. |
| Benzathine penicillin G (injection) | 1.2 million units IM × 1 dose (adults) 600,000–1.2M units IM × 1 dose (children) |
Useful when adherence to oral therapy is a concern. Compliance guaranteed with a single injection. |
Penicillin-Allergic Patients
For patients with a documented penicillin allergy, options depend on the nature of the allergy. Many patients who report penicillin allergy are not truly allergic — the reported reaction was often a rash from amoxicillin during a viral illness (which, as noted above, can occur with EBV). That said, when genuine allergy is documented:
- Cephalexin (first-generation cephalosporin): 500 mg twice daily × 10 days. Safe for most patients with a mild non-anaphylactic penicillin allergy. Cross-reactivity with penicillin is roughly 1–2% for cephalosporins, and far lower for first-generation agents specifically.
- Azithromycin (Z-Pak): 500 mg on day 1, then 250 mg once daily for days 2–5. Convenient but watch for GAS macrolide resistance, which runs 5–20% in many U.S. communities.
- Clindamycin: 300 mg three times daily × 10 days. Reserved for patients allergic to both penicillin and macrolides, or when macrolide resistance is suspected.
Why 10 Days?
Shorter antibiotic courses have been tested for strep throat, and most studies show that a 5-day course is less effective at eradicating GAS and preventing complications compared to the full 10-day course.[6] Patients nearly always feel significantly better within 2–3 days of starting antibiotics — but stopping early leaves viable bacteria behind and increases the risk of recurrence and rheumatic fever. Complete the full course, even when you feel well.
Symptomatic Treatment for Viral Sore Throats
Most sore throats are viral. Antibiotics won't help them — they won't shorten the illness, won't reduce symptoms, and carry real costs in side effects and antibiotic resistance. What actually works for symptom relief:
Analgesics and Anti-Inflammatories
Ibuprofen (Advil, Motrin) is my first recommendation for throat pain when there are no contraindications. Anti-inflammatory medications provide noticeably better throat pain relief than acetaminophen alone, because part of what hurts is the inflammatory swelling — not just pain signals. 400–600 mg every 6–8 hours with food. For children, weight-based dosing; do not use ibuprofen in children under 6 months.
Acetaminophen (Tylenol) is a good alternative or can be alternated with ibuprofen for better pain control. Standard adult dosing: 500–1,000 mg every 4–6 hours, not exceeding 4,000 mg in 24 hours (less if any liver disease or regular alcohol use).
One important note: aspirin should not be given to children or teenagers with viral illnesses, due to the risk of Reye's syndrome — a rare but potentially fatal liver and brain condition.[6]
Topical Treatments
- Throat lozenges: Those containing benzocaine or menthol provide direct local analgesia. Temporary but useful, especially for easing swallowing enough to drink fluids.
- Salt water gargles: One-half teaspoon of salt in 8 ounces of warm water, gargled for 30 seconds several times daily. Clinically modest in effect but inexpensive, safe, and soothing for many patients.
- Cold liquids and ice chips: Cold has a direct analgesic effect on inflamed throat tissue. Popsicles and ice cream are genuinely therapeutic, not just comfort foods.
- Honey: For patients older than 1 year (never for infants due to botulism risk), honey in warm tea or water provides throat coating and mild antimicrobial activity. The evidence in adults is modest but it's safe and affordable.
Hydration and Rest
Staying well-hydrated is not optional — a dry, dehydrated mucous membrane is far more painful and more vulnerable to secondary infection than one that's well-moistened. If swallowing is too painful for regular liquids, cold smoothies, broths, and meal replacement drinks can help maintain intake.
Humidifiers
Dry air — especially in heated winter homes — worsens throat irritation significantly. A cool-mist humidifier in the bedroom can reduce overnight discomfort. Keep it clean to prevent mold.
When to See a Doctor — A Decision Framework
Not every sore throat needs a doctor visit. But certain situations warrant prompt evaluation. Here's how I think through this for patients who call my office:
| Situation | What to Do | Why |
|---|---|---|
| Mild throat soreness with runny nose, cough, no fever | Home treatment; no visit needed | Classic viral presentation — antibiotics won't help, and symptoms typically resolve in 7–10 days |
| Moderate to severe sore throat, fever, no cough or runny nose | See a physician or urgent care for strep testing | McIsaac score likely ≥2; test to confirm or rule out bacterial cause |
| Confirmed or highly suspected strep exposure at home or school | See a physician even if symptoms are mild | High-risk exposure overrides low clinical score; testing warranted per 2025 IDSA guidelines |
| Sore throat lasting more than 7–10 days without improvement | Schedule an appointment | Prolonged illness warrants evaluation for mono, secondary bacterial infection, or other causes |
| Sore throat with fever, fatigue, and swollen glands throughout the body | See a physician | Pattern consistent with mononucleosis — requires specific testing and different management |
| Sore throat with any red flag symptoms (see below) | Emergency department immediately | Potential life-threatening complications requiring urgent intervention |
Telehealth is a practical option for many of these situations. I can evaluate a sore throat via video visit, review your symptom pattern, apply the Centor/McIsaac criteria, and determine whether you need an in-person test or can be managed remotely. For straightforward cases with a clear clinical picture, this saves considerable time and reduces exposure for both patients and others in waiting rooms.
Red Flags — Peritonsillar Abscess, Epiglottitis, and Severe Symptoms
- Difficulty breathing or noisy breathing (stridor) — potential airway compromise; this is a life-threatening emergency
- Drooling or inability to swallow saliva — suggests severe swelling that may indicate peritonsillar abscess or epiglottitis
- Severe one-sided throat pain with a muffled, "hot potato" voice and difficulty opening the mouth wide (trismus) — peritonsillar abscess until proven otherwise
- Stiff neck and high fever — possible meningitis, particularly in combination with sore throat
- Visible uvular deviation (the small dangling tissue at the back of the throat is pushed to one side) — sign of peritonsillar abscess
- Fever above 103°F (39.4°C) with severe throat pain that is not responding to pain medications
- Symptoms in an immunocompromised patient — cancer, HIV, organ transplant, or on biologics — escalating faster than expected
Peritonsillar Abscess
A peritonsillar abscess (PTA) is a collection of pus in the soft tissue behind the tonsil. It is the most common serious complication of bacterial pharyngitis and tonsillitis, and the most common deep neck space infection seen in adolescents and young adults.[7]
The presentation is distinctive once you know what to look for: severe throat pain that is predominantly on one side, a muffled voice described as sounding like someone talking with a hot potato in their mouth, inability to open the mouth fully (trismus from muscle spasm), drooling, and the uvula visibly pushed toward the unaffected side. Neck stiffness is common.
This is not a condition that can be treated with oral antibiotics at home. A peritonsillar abscess requires needle aspiration or surgical incision and drainage, along with intravenous antibiotics. Delay in treatment can lead to spread into the parapharyngeal or retropharyngeal spaces — deep neck infections that can compromise the airway.
Epiglottitis
Epiglottitis — infection and swelling of the epiglottis, the small flap of cartilage that covers the airway during swallowing — is a genuine airway emergency. The Haemophilus influenzae type b vaccine has made classic childhood epiglottitis rare, but cases still occur in adults and in unvaccinated individuals.
The classic triad is fever, severe odynophagia (pain with swallowing), and drooling. Patients often lean forward (the "tripod position") to keep the airway open. If epiglottitis is suspected, do not attempt to visualize the throat directly — the stimulus can trigger laryngospasm and complete airway obstruction. This is a 911 call.
Retropharyngeal and Parapharyngeal Abscess
These deep neck space infections are rarer but serious. They typically produce fever, stiff neck, limited neck movement, and a toxic-appearing patient. Children are more commonly affected than adults. If a sore throat patient has marked trismus, dysphagia, or neck swelling that moves with swallowing, imaging and emergency evaluation are needed.
Sore Throat in Adults vs. Children
The approach to pharyngitis differs meaningfully between age groups, and these differences matter practically.
Children (Ages 3–15)
Strep throat is more common in children than adults — accounting for 15–30% of pediatric pharyngitis cases versus 5–15% in adults.[1] Children are also at higher risk for rheumatic fever and its cardiac complications, which is a strong driver of the more aggressive testing and treatment approach in pediatrics. Group A Strep pharyngitis in children under 3 is less common (GAS rarely causes pharyngitis in this very young age group), but testing is still appropriate when there is household exposure or high clinical suspicion.
Strep season in children follows the school calendar. Infections peak in late fall and early winter when children return to school, and the regional patterns of GAS pharyngitis are closely tied to school start dates — the South typically sees the first surge.[5]
Tonsillectomy is sometimes recommended for children with recurrent strep throat — typically defined as 7 or more episodes in a year, or 5 per year for two consecutive years. The decision is individualized and should involve a pediatric otolaryngologist (ENT) when recurrent strep is causing significant school absences or quality-of-life impact.
Adults
In adults, the probability of strep is lower, and the risk of rheumatic fever — while not zero — is lower than in children. The approach is therefore somewhat less aggressive. Adults with McIsaac scores of 0–1 can safely forgo testing and antibiotics. The guideline emphasis in adults is avoiding unnecessary antibiotic prescriptions, given the significant overtreatment problem documented in the literature.[8]
Older adults present a different challenge. Classic symptoms of fever and tonsillar exudates may be blunted in elderly patients, and sore throat may be less prominent than in younger patients with the same infection. Comorbidities like diabetes and immunosuppression lower the threshold for prompt evaluation.
Pregnant Women
Strep throat in pregnancy should be treated with antibiotics without delay. Amoxicillin and penicillin are safe in all trimesters. Azithromycin is generally considered safe if penicillin is contraindicated. Avoid tetracyclines. Beyond preventing complications for the mother, treating maternal GAS reduces the (rare but serious) risk of neonatal group B strep disease from related streptococcal infections.
Prevention
Strep throat spreads primarily through respiratory droplets — coughing, sneezing, and close contact. It also spreads through shared eating utensils, drinking glasses, and surfaces contaminated by hand-to-mouth transfer. Practical prevention:
- Hand hygiene: Washing hands frequently with soap and water for at least 20 seconds, especially after contact with someone who is ill, remains the most effective single intervention.
- Avoid sharing utensils and drinks: Direct transfer of bacteria and viruses via shared cups and utensils is a documented transmission route.
- Stay home when contagious: Patients with strep should remain home from school or work until they have been on antibiotics for at least 24 hours and are fever-free. Untreated strep can remain contagious for 2–3 weeks.
- Cover coughs and sneezes: Into the elbow, not the hand. Respiratory droplets are the primary transmission vehicle for both strep and viral pharyngitis.
- Disinfect shared surfaces: Countertops, doorknobs, and phones in shared spaces are worth regular disinfection during strep outbreaks at home or school.
- Replace toothbrushes: After being treated for strep throat, replacing the toothbrush reduces the risk of reinfection. The bacteria can survive on toothbrush bristles.
- Flu vaccination: Influenza is a common cause of sore throat and severe pharyngitis. Annual flu vaccination reduces the overall burden of respiratory illness, including throat-related symptoms.
There is no vaccine for group A Streptococcus currently available for clinical use, though vaccine research is ongoing. COVID-19 vaccination and booster doses reduce the risk of COVID-related pharyngitis, which has become an increasingly common cause of sore throat since 2020.
Frequently Asked Questions
No single symptom reliably separates strep from viral pharyngitis, but certain patterns raise or lower suspicion. Fever, swollen tender lymph nodes at the front of the neck, tonsillar swelling or white patches, and the absence of cough and runny nose all point toward strep. The presence of runny nose, hoarseness, conjunctivitis, or mouth sores strongly suggests a virus. Clinicians use the Centor or McIsaac scoring system to estimate the probability of strep and decide whether to test. A positive rapid strep test or throat culture is the only way to confirm the diagnosis.
Yes — confirmed strep throat should be treated with antibiotics. Left untreated, strep can cause serious complications including rheumatic fever, which can permanently damage heart valves, and post-streptococcal glomerulonephritis, which affects kidney function. Antibiotics also shorten the duration of illness, reduce the risk of spreading the infection to others, and lower the chance of local complications like peritonsillar abscess. Viral sore throats, by contrast, do not benefit from antibiotics.
Without treatment, strep throat remains contagious for 2 to 3 weeks, even after symptoms improve. With antibiotic treatment, the contagious period drops dramatically — most patients are no longer contagious after 24 hours on appropriate antibiotics. This is one of the practical reasons to test and treat promptly, especially for school-age children and anyone who lives with high-risk individuals.
Yes. Tonsillectomy significantly reduces the frequency of recurrent strep throat, but it does not eliminate the possibility entirely. The pharynx still carries surface tissue that group A Streptococcus can infect, even after the tonsils are removed. The illness tends to be milder and less frequent after tonsillectomy, but strep pharyngitis can still occur.
A peritonsillar abscess is a collection of pus that forms behind the tonsil — the most common serious complication of strep throat. It typically causes severe one-sided throat pain, a muffled "hot potato" voice, difficulty opening the mouth wide (trismus), drooling, and deviation of the uvula toward the opposite side. This requires drainage and intravenous antibiotics — it's a medical emergency. If your sore throat is predominantly one-sided and severe, you have trouble swallowing your own saliva, or your voice sounds unusually muffled, go to an emergency department immediately.
Yes, until your child has been on antibiotics for at least 24 hours and is fever-free. At that point, the risk of spreading the infection drops significantly. Complete the full antibiotic course — typically 10 days for penicillin or amoxicillin — even if your child feels completely better after a few days. Stopping antibiotics early increases the risk of treatment failure and complications.
References
- Infectious Diseases Society of America (IDSA). Clinical Practice Guideline Update on Group A Streptococcal Pharyngitis. October 2025. https://www.idsociety.org/practice-guideline/streptococcal-pharyngitis2/
- Infectious Diseases Society of America. IDSA Releases New Guidelines for Diagnosing Strep Throat. October 14, 2025. https://www.idsociety.org/news--publications-new/articles/2025/idsa-releases-new-guidelines-for-diagnosing-strep-throat/
- Fine AM, Nizet V, Mandl KD. Large-Scale Validation of the Centor and McIsaac Scores to Predict Group A Streptococcal Pharyngitis. Arch Intern Med. 2012;172(11):847–852. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1157417
- Fine AM, Nizet V, Mandl KD. Large-Scale Validation of the Centor and McIsaac Scores. PMC Full Text. 2012. https://pmc.ncbi.nlm.nih.gov/articles/PMC3627733/
- Steer AC, Lamagni T, Curtis N, Carapetis JR. The global burden of sore throat and group A Streptococcus. EClinicalMedicine. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9124702/
- Mayo Clinic Staff. Strep Throat — Symptoms and Causes. Mayo Clinic. November 2022. https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338
- Galioto NJ. Peritonsillar Abscess. StatPearls. January 2026. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK519520/
- Barnett ML, Linder JA. Antimicrobial Prescribing in the U.S. for Adult Acute Pharyngitis in Ambulatory Care Settings. J Eval Clin Pract. 2010. https://pmc.ncbi.nlm.nih.gov/articles/PMC2978269/