It is one of the most common questions we are asked across the counter, and it usually arrives already half-answered: "I think I need antibiotics for this."
Sometimes that's right. Most of the time it isn't — and the reason why is genuinely worth understanding, because it changes what you do instead.
This guide covers how the decision is actually made, what helps when antibiotics won't, and when a sore throat stops being a nuisance and becomes something urgent. Qrystal Pharmacy is on Borough High Street, a few minutes from Borough station and about eight from London Bridge, and we assess sore throats on the NHS without an appointment.
Most sore throats are viral
The great majority of sore throats are caused by viruses — the same ones behind colds and flu. They come on over a day or two, feel worst around day three, and settle within about a week.
A smaller share, roughly one in three in adults and rather more in children, are caused by Streptococcus bacteria. Those are the ones where antibiotics can shorten symptoms and reduce the small risk of complications.
The problem is that the two feel remarkably similar from the inside. Severe pain is not a reliable signal — viral throats can be agonising, and streptococcal ones can be mild. You cannot tell from how much it hurts, and neither can we without assessing you properly.
How a pharmacist actually decides
This is the part almost nobody is told, and it makes the whole thing less arbitrary.
We use a validated NHS scoring system called FeverPAIN, which looks at five specific features:
- Fever in the last 24 hours
- Purulence — pus on the tonsils
- Attend rapidly — you came within three days of symptoms starting
- Inflamed tonsils, severely so
- No cough or coryza (no cold symptoms)
Each one that applies adds a point. A low score points strongly towards a viral cause, where antibiotics would do nothing useful. A high score raises the probability of a bacterial infection enough that antibiotics become worth considering.
That last criterion surprises people, so it's worth drawing out: a cough and a runny nose make a bacterial throat infection less likely, not more. Cold symptoms alongside a sore throat are reassuring. They point to a virus, which points away from antibiotics.
The assessment takes about ten to fifteen minutes in our private consultation room, including looking at your throat. It's free on the NHS.
What genuinely helps when it's viral
"No antibiotics" is not the same as "nothing to be done". For a viral sore throat, the aim is controlling pain while your immune system finishes the job.
Regular pain relief, taken properly. Paracetamol or ibuprofen at the correct dose and interval does more than most people give it credit for — largely because most people take it sporadically once the pain is already bad, rather than regularly for the two or three worst days. Ask us what's suitable alongside anything else you take.
Anaesthetic lozenges and sprays. These numb rather than treat, which is exactly what's wanted for painful swallowing. Medicated lozenges containing an antiseptic are also available; both work best for short-term relief.
Fluids, and cold things. Painful swallowing makes people drink less, which makes everything worse. Cold drinks and ice lollies are genuinely useful, particularly for children who are refusing to drink.
Warm drinks with honey. Not a folk remedy so much as a soothing demulcent — honey has reasonable evidence behind it for throat symptoms. Not for infants under one year.
Rest, and staying home if you can. Two days at home beats a fortnight of passing it around an open-plan office.
Salt-water gargling helps some people and costs nothing worth mentioning.
What doesn't help: leftover antibiotics from a previous illness, antibiotics obtained without assessment, or high-dose vitamin C started after symptoms begin. The NHS overview of sore throat covers the self-care ground in more detail.
What about a strep test?
People often arrive asking for a swab, on the reasonable assumption that a test would settle it definitively. Under Pharmacy First the assessment is clinical scoring rather than swabbing, and there are sound reasons for that.
A throat swab takes days to culture, which is longer than most sore throats last — the answer arrives after the decision needed making. Rapid antigen tests are quicker but bring their own problem: a meaningful number of perfectly well people carry Streptococcus in the throat without it causing anything. A positive result in someone with a viral sore throat can therefore point at the wrong culprit and produce an antibiotic that wasn't needed.
FeverPAIN was developed and validated precisely to make this call at the point of care, in one visit, without waiting. It isn't a compromise on testing — for an acute sore throat it's the tool that best matches the decision being made.
Why "just in case" antibiotics are a bad trade
It's tempting to think an unnecessary antibiotic is harmless — worth taking on the off-chance. It isn't neutral, for two reasons.
They have effects even when they aren't working. Nausea, diarrhoea, thrush and rash are common. For a viral throat, that's a real cost against no benefit at all.
They make future infections harder to treat. Every unnecessary course applies selective pressure that favours resistant bacteria — in you, and in the community around you. We've written about this in more depth in our guide to antibiotic resistance.
A pharmacist declining to supply antibiotics is not being obstructive. It's the same clinical judgement that supplies them when the score justifies it — which we do, on the spot, in the same visit.
When a sore throat is urgent
Most sore throats are uncomfortable and unremarkable. A small number are not, and these need same-day medical assessment rather than a pharmacy consultation.
Seek urgent help — NHS 111, or 999 for breathing difficulty — if there is:
- Difficulty breathing, or noisy breathing
- Difficulty swallowing saliva, or drooling
- A muffled or "hot potato" voice
- Severe one-sided throat pain, particularly with difficulty opening the mouth fully
- A child who is floppy, unresponsive, or has a rash that doesn't fade under pressure
Also see a GP rather than us if your sore throat has lasted more than two weeks, keeps coming back, or comes with a persistently swollen neck. Our guide to urgent care near Borough sets out what belongs where.
Who we can see
Under Pharmacy First, our sore throat service covers:
- Adults and children aged 5 and over
- Registered with an NHS GP in England
- With an acute sore throat, typically under two weeks
We refer rather than treat for children under 5, recurrent severe tonsillitis that may need ENT review, and anyone with the red-flag features above. NHS England's Pharmacy First pages set out the national scheme.
Full details, including what to expect step by step, are on our sore throat treatment page.
Sore throats in SE1
There's a reason we see a lot of these, and it isn't bad luck.
This is a district of shared air. Tens of thousands of people move through London Bridge station every working day; the Northern line at Borough is not a spacious environment in February; the offices along Tooley Street and More London are open-plan; and Guy's Hospital staff spend their days in exactly the settings where respiratory viruses circulate. Add the crowds around Borough Market at weekends and you have an efficient distribution network for anything airborne.
The practical upshot is that a sore throat here is usually viral, usually caught from someone standing very close to you, and usually best handled by staying home for a couple of days rather than pushing through. If you'd like the broader seasonal picture, our winter health checklist covers vaccination and prevention.
Where to find us
Qrystal Pharmacy, 301 Borough High Street, London SE1 1JH.
- Borough Underground (Northern line): about 2 minutes' walk
- London Bridge (Northern & Jubilee lines, National Rail): about 8 minutes
- Guy's Hospital: roughly 10 minutes on foot
- Buses: frequent routes stop directly outside
Open Monday to Friday 9:00–18:30, Saturday 9:00–14:00.
Get it assessed
- Call: 020 7403 2237
- Visit: 301 Borough High Street, London SE1 1JH — walk in, no appointment
- Book a consultation if you'd rather reserve a slot
You don't need to have decided whether it's viral before you come. Working that out is the consultation — and whichever way it goes, you'll leave knowing what will actually help.
