Streptococcal pharyngitis

Background

• Strep pharyngitis
  • Peak in 5-15yr old
  • Rare in <2yr of age
  • Accounts for only 15-30% of pharyngitis

Clinical Features

• Sore throat
• Painful swallowing
• Fever
• N/V
• Tonsillar exudate
• Palatal petechiae

Diagnosis - Centor Criteria

1. History of fever
2. Absence of cough
3. Lymphadenopathy
4. Tonsillar exudate or swelling

Points	Treatment
4	Rx without testing
3	Rapid Strep Test
2	Rapid Strep Test
1	Do not test/treat
0	Do not test/treat

• Likelihood of streptococcal pharyngitis in pts presenting with sore throat
  • 4 criteria = 50% PPV
  • 3 criteria = 40% PPV
  • 0 criteria - 80% NPV

Differential Diagnosis

Pharyngitis

• Viral pharyngitis
• Retropharyngeal abscess
• CMV pharyngitis
• Gonococcal pharyngitis

Others

• EBV pharyngitis
• Acute HIV
• Lemierre's Syndrome
• PTA
• Retropharyngeal Abscess
• Ludwig's Angina
• Epiglottitis

Treatment

Antibiotics

Tx can be delayed for up to 9 days and still prevent major sequelae

Penicillin Options:

• Penicillin V 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent)
• Bicillin L-A 25-50K mg/kg IM x 1 (max dose = 1.2million)

Penicillin allergic (mild):

• Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d

Penicillin allergic (anaphylaxis):

• Clindamycin 7.5mg/kg PO QID x 10d (child) or 450mg PO TID x 10d OR
• Azithromycin 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5

Steroids

• Single dose of dexamethasone shortens duration of pain
• Dexamethasone 0.6mg/kg PO

See Also

• Peritonsilar Abscess
• Sore Throat

External Links

• SmartEM Pharyngitis

Source

• Tintinalli
• Rosen's
• Logan LK, McAuley JB, Shulman ST. [Macrolide treatment failure in streptococcal pharyngitis resulting in acute rheumatic Fever]. Pediatrics. 2012 Mar;129(3):e798-802. Epub 2012 Feb 6.

Authors

Ross Donaldson, Daniel Ostermayer, Timothy Peck, Jordan Swartz, Brian Gilberti, Allen Bookatz, Jonathan Osgood