# Adherence to NICE Guidelines and Centor Criteria in Acute Sore Throat Management: An Audit Cycle

## TL;DR

This study shows that educating clinicians on guidelines improves antibiotic use for sore throats, helping reduce antibiotic resistance.

## Contribution

The study demonstrates improved adherence to guidelines and reduced inappropriate antibiotic prescribing after clinician education.

## Key findings

- Before education, 48% of clinicians incorrectly prescribed antibiotics for sore throats.
- After education, 54% of clinicians documented all Centor criteria and 56% prescribed appropriate antibiotics.

## Abstract

Introduction

Antibiotic stewardship is becoming critically important as resistant bacteria become increasingly prevalent. Antimicrobial resistance (AMR) has emerged as a major global health challenge, driven in part by the misuse and overuse of antibiotics. An acute sore throat is one of the most frequent reasons for patients to seek medical care, yet only a minority of cases require antibiotic treatment. Despite this, inappropriate prescribing is rife, often influenced by diagnostic uncertainty, patient expectations, and non-clinical pressures. These challenges highlight the importance of reinforcing evidence-based strategies, such as the use of Centor criteria, to support accurate assessment and reduce unnecessary antibiotic prescribing in patients presenting with a sore throat.

This quality improvement project evaluated adherence to Centor criteria and subsequent antibiotic prescribing in an accident and emergency (A&E) department in the Northwest of England, before and after clinician education on NICE guidance and documentation of Centor criteria.

Materials and methods

One hundred patients presenting with an acute sore throat between January and March 2023 were identified. Electronic patient data were collected retrospectively to analyze the documentation’s adherence to NICE guidelines and Modified Centor criteria.

Results

Pre-intervention, 16% of clinicians documented all Centor criteria, 48% incorrectly prescribed antibiotics, and only 20% prescribed appropriate antibiotics. Through post-intervention teaching and literature dissemination, the figures changed to 54%, 22%, and 56%, respectively.

Conclusion

Targeted clinician education and adherence to NICE guidelines improved antibiotic prescribing for the acute sore throat, underscoring the value of audit cycles while highlighting the need for sustained, larger-scale efforts to reduce AMR.