Expert Consensus Recommendations on Adult Acute Sore Throat Management in Southeast Asia: A Modified Delphi Statement
Through a modified Delphi process involving 13 experts from six Southeast Asian countries, this study establishes a regionally harmonised consensus recommending the use of McIsaac scoring with targeted testing and specific symptomatic therapies to optimise adult sore throat management and combat antimicrobial resistance.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every time a throat feels raw and scratchy, a familiar question arises: is it a virus that will pass on its own, or a bacteria that needs medicine to stop? For decades, doctors have known that most sore throats are caused by viruses, which do not respond to antibiotics. These drugs are designed to kill bacteria, and using them when they are not needed does not help the patient feel better. Instead, it contributes to a growing global crisis where bacteria learn to survive the very medicines meant to cure them. This problem is particularly acute in Southeast Asia, a region where the misuse of antibiotics has accelerated the rise of resistant infections. When people believe antibiotics are a cure-all for any illness, or when doctors feel unsure about the cause of a patient's pain, the result is often a prescription that offers little benefit but carries significant long-term risks.
To address this, a group of thirteen medical experts from six Southeast Asian nations came together to create a clear, shared guide for managing adult sore throats. They did not simply repeat existing rules from other parts of the world; instead, they built a plan that fits the specific realities of their region, where access to rapid diagnostic tools can be limited and patient expectations often lean toward immediate medication. The group, which included ear, nose, and throat specialists, primary care doctors, and a pharmacist, used a structured method to review the best available evidence and reach a unanimous agreement on how to treat patients. Their goal was to find a way to relieve suffering without fueling the spread of drug-resistant bacteria.
The experts found that the main reasons for overprescribing antibiotics were not just medical, but also social. Many patients in the region mistakenly believe that antibiotics work against viruses, leading them to demand these drugs for conditions that do not require them. At the same time, doctors often feel uncertain about whether a patient has a bacterial infection, and without a quick way to test, they may prescribe antibiotics just to be safe. The consensus group agreed that this approach is harmful. It exposes patients to unnecessary side effects, increases healthcare costs, and accelerates the development of resistance. The solution they proposed relies on a simple, step-by-step approach that starts with a careful look at the patient's symptoms.
The group recommended using a specific scoring system to estimate the likelihood of a bacterial infection. This system, known as the McIsaac score, asks a doctor to check for a few key signs: whether the patient has a fever, swollen glands in the neck, white patches on the tonsils, and whether they have a cough. The presence of these signs, along with the patient's age, helps the doctor decide how likely it is that the sore throat is caused by a bacterium called Group A Streptococcus. If the score is low, the infection is almost certainly viral, and antibiotics should not be given. If the score is high, the infection is likely bacterial, and antibiotics are the correct treatment. For patients in the middle range, where the doctor is unsure, the group strongly advised using a rapid test if one is available. This test can quickly tell if the specific bacteria are present, allowing the doctor to prescribe antibiotics only when they are truly needed.
Perhaps the most significant part of their agreement was the emphasis on treating the pain itself. The experts noted that when patients ask for antibiotics, they are often really asking for relief from the pain and discomfort of a sore throat. Since antibiotics provide very little relief for viral infections and only shorten the duration of symptoms by a few hours at best, the group argued that the focus should shift to managing the pain directly. They endorsed the use of topical treatments, such as lozenges or sprays containing a specific anti-inflammatory drug called flurbiprofen. These treatments work right at the source of the pain, reducing inflammation and numbing the throat quickly. Because they act locally, they avoid the side effects that can come from swallowing painkillers. The consensus was that by providing effective, fast-acting relief for the throat pain, doctors can satisfy the patient's need for help without resorting to unnecessary antibiotics.
The final recommendations also included clear instructions for when to seek more advanced care. If a patient shows signs of a severe complication, such as difficulty breathing, a high fever that does not go away, or a lump in the neck, they should be referred to a specialist immediately. However, for the vast majority of cases, the path forward is clear: use a simple checklist to assess the risk, test when possible, treat the pain with targeted local medicines, and reserve antibiotics only for confirmed bacterial cases. This approach, developed by local experts for local conditions, offers a practical way to protect patients from the immediate pain of a sore throat while also protecting the community from the long-term threat of drug-resistant bacteria. By aligning what patients expect with what doctors know is safe and effective, the group hopes to change the way sore throats are treated across Southeast Asia, turning a common ailment into an opportunity to fight a much larger global health challenge.
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