AskCalc
Home › Infectious Disease › FeverPAIN

FeverPAIN Score for Streptococcal Pharyngitis

FeverPAIN scores 1 point each for Fever in the past 24 h, Purulence, Attending rapidly (≤3 days), severely Inflamed tonsils and No cough or coryza (0–5). 0–1: no antibiotic; 2–3: consider no or delayed antibiotic; 4–5: immediate or delayed antibiotic (NICE NG84).

  • Fever in past 24 hours (yes/no, +1)
  • Purulence (pharyngeal/tonsillar exudate) (yes/no, +1)
  • Attended rapidly (symptom onset ≤3 days) (yes/no, +1)
  • Severely inflamed tonsils (yes/no, +1)
  • No cough or coryza (yes/no, +1)
—

Interpretation

ResultMeaning
0–1No antibiotic (~13–18% strep)
2–3No or back-up antibiotic (~30–48%)
4–5Immediate or back-up antibiotic (~62–65%)

Formula

Fever (24 h) 1 · Purulence 1 · Attend rapidly ≤3 days 1 · severely Inflamed tonsils 1 · No cough/coryza 1

Clinical pearls

  • Developed in UK primary care for ages ≥3; used by NICE in place of Centor in the UK.
  • Red flags (quinsy, airway compromise, systemic illness) override the score.
  • Deliberate difference from MedCalc-Bench: there, a missing "absence of cough/coryza" item is scored as +1; here every item must be answered.

Examples

feverpain fever, purulent tonsils, 2 days of symptoms, no coughfever pain score: no fever, exudate, inflamed tonsils, has cough, onset 5 days ago

FAQ

FeverPAIN or Centor?

Both predict streptococcal pharyngitis. FeverPAIN was derived in UK primary care and is recommended by NICE; Centor/McIsaac is more common in North America.

What FeverPAIN score needs antibiotics?

At 4–5 consider an immediate or back-up antibiotic; at 2–3 consider no antibiotic or a back-up prescription; at 0–1 antibiotics are not recommended.

Evidence

  1. Little P et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM. BMJ 2013;347:f5806.
  2. MedCalc-Bench reference implementation (feverpain.py).

Infectious Disease · Reviewed 2026-10-14 · Methodology