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FeverPAIN and Centor are clinical scoring tools that help identify people with a sore throat who are more likely to have a streptococcal infection, and so more likely to benefit from antibiotics.
FeverPAIN score
Score one point for each of the five features below, giving a total of 0 to 5.
| Table 1: FeverPAIN criteria |
| Feature |
Score |
| Fever (during previous 24 hours) |
1 |
| Purulence (pus on tonsils) |
1 |
| Attend rapidly (within 3 days after onset of symptoms) |
1 |
| Severely Inflamed tonsils |
1 |
| No cough or coryza (coryza is inflammation of the nasal mucous membranes) |
1 |
| Table 2: FeverPAIN score, likelihood of streptococcal infection and CKS advice |
| FeverPAIN score |
Likelihood of isolating streptococcus |
Antibiotic advice |
| 0 or 1 |
13 to 18% |
Do not offer an antibiotic prescription |
| 2 or 3 |
34 to 40% |
Consider no antibiotic prescription, or a back-up antibiotic prescription |
| 4 or 5 |
62 to 65% |
Consider an immediate antibiotic prescription or a back-up antibiotic prescription |
Centor score
Score one point for each of the four features below, giving a total of 0 to 4.
| Table 3: Centor criteria |
| Feature |
Score |
| Tonsillar exudate |
1 |
| Tender anterior cervical lymphadenopathy or lymphadenitis |
1 |
| History of fever (over 38°C) |
1 |
| Absence of cough |
1 |
| Table 4: Centor score, likelihood of streptococcal infection and CKS advice |
| Centor score |
Likelihood of isolating streptococcus |
Antibiotic advice |
| 0, 1 or 2 |
3 to 17% |
Do not offer an antibiotic prescription |
| 3 or 4 |
32 to 56% |
Consider an immediate antibiotic prescription or a back-up antibiotic prescription |
| Immediate and back-up prescriptions |
| ● |
Offer an immediate antibiotic prescription to people who are systemically very unwell, have symptoms and signs of a more serious illness or condition, or are at high risk of complications. |
| ● |
If a back-up antibiotic prescription is given, advise that an antibiotic is not needed immediately. It should be used if symptoms do not start to improve within 3 to 5 days, or if they worsen rapidly or significantly at any time. |
| ● |
If no antibiotic is offered, advise that one is not needed and that the person should seek medical help if symptoms worsen rapidly or significantly, do not start to improve after 1 week, or they become systemically very unwell. |
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| Points to remember |
| ● |
Higher scores suggest more severe symptoms and a likely bacterial (streptococcal) cause. |
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Either FeverPAIN or Centor can be used to help decide whether to prescribe an antibiotic. |
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Antibiotics make little difference to how long symptoms last (on average, they shorten symptoms by about 16 hours), and most people feel better after 1 week with or without antibiotics. |
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Related content
| CKS summary |
| Sore throat - acute |
| Clinical knowledge summary on the management of acute sore throat, including when to offer an antibiotic. Last revised May 2026. |
| Read more → |
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