Acute throat pain, usually <2 weeks
Reasoning goal: viral vs GAS vs airway/deep infection risk
Therapeutic goal: symptom relief first, then antibiotics only when justified

Throat pain & odynophagia (include unilateral vs bilateral)

Systemic features: fever, rigors, toxic appearance

Viral features: cough, coryza, hoarseness, conjunctivitis

Airway compromise: stridor, drooling, distress, cannot swallow fluids

Quinsy pattern: unilateral severe pain + trismus + muffled voice

Supraglottitis: severe pain with relatively normal throat exam

Tonsillar exudate (supports, not specific)

Tender anterior cervical nodes (GAS-likely feature)

Posterior nodes + fatigue (consider EBV)

Systemic toxicity or sepsis trajectory

Persistent unilateral symptoms or neck mass (non-infective pathways)

Anchoring check: am I calling this “tonsillitis” just because it is red?

Alternative hypothesis: EBV vs quinsy vs supraglottitis vs irritant/reflux

Trajectory rule: worsening after initial improvement is a pattern shift

Safety audit: swallow, breathing, dehydration, systemic toxicity

Step 2: Antibiotic strategy by probability (score + pattern + safety gates)

Step 3: Back-up prescription when uncertainty is the key issue

Step 4: Safety-net with clear review triggers and expected course

Step 1: Symptom control first (analgesia and hydration)

Viral pharyngitis

GAS tonsillitis

Peritonsillar abscess (quinsy)

Supraglottitis / epiglottitis

Urgent: airway risk (drooling, stridor, cannot swallow)

Urgent: quinsy / deep infection pattern (trismus, unilateral severe pain)

Consider ENT discussion for recurrent tonsillitis burden

Expected improvement over days, most settle around a week

Return urgently if swallow or breathing worsens, drooling, trismus, neck swelling

If persistent or atypical: do a diagnostic timeout and reframe the DDx

Reflux / irritant throat

Infectious mononucleosis (EBV)