Streptococcal pharyngitis: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Peak in 5-15yr old | |||
*Rare in <2yr of age | |||
*Accounts for only 15-30% of pharyngitis | |||
==Clinical Features== | |||
[[File:Pos strep.jpg|thumb|culture positive strep pharyngitis with typical tonsillar exudate]] | [[File:Pos strep.jpg|thumb|culture positive strep pharyngitis with typical tonsillar exudate]] | ||
*[[Sore throat]] | |||
*Sore throat | |||
*Painful swallowing | *Painful swallowing | ||
*Fever | *[[Fever]] | ||
* | *[[Nausea and vomiting]] | ||
*Tonsillar exudate | *Tonsillar exudate | ||
*Palatal petechiae | *Palatal petechiae | ||
| Line 70: | Line 68: | ||
{{Streptococcal Pharyngitis Antibiotics}} | {{Streptococcal Pharyngitis Antibiotics}} | ||
===Steroids=== | ===[[Steroids]]=== | ||
*Single dose of [[dexamethasone]] shortens duration of pain | *Single dose of [[dexamethasone]] shortens duration of pain | ||
**[[Dexamethasone]] 0.6mg/kg PO - maximum of 10 mg | **[[Dexamethasone]] 0.6mg/kg PO - maximum of 10 mg | ||
Revision as of 12:00, 15 December 2015
Background
- Peak in 5-15yr old
- Rare in <2yr of age
- Accounts for only 15-30% of pharyngitis
Clinical Features
- Sore throat
- Painful swallowing
- Fever
- Nausea and vomiting
- Tonsillar exudate
- Palatal petechiae
Complications
- Acute rheumatic fever
- Scarlet fever
- Toxic shock syndrome
- Post-streptococcal glomerular nephritis
- PANDAS syndrome
- Peritonsillar abscess
- Cervical lymphadenitis
- Mastoiditis
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
Diagnosis
Modified Centor Criteria[1]
One point is given for each of the criteria:[1]
- Absence of a cough
- Swollen and tender cervical lymph nodes
- Temperature >38.0 °C (100.4 °F)
- Tonsillar exudate or swelling
- Age less than 15 (a point is subtracted if age >44)^
| Points | Probability of Strep | Management |
|---|---|---|
| 1 or fewer | <10% | No antibiotic or culture needed |
| 2 | 11–17% | Antibiotic based on rapid strep or culture |
| 3 | 28–35% | |
| 4 or 5 | 52% | Empiric antibiotics |
^Testing is not needed in children <3 years old as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.[2]
Management
Antibiotics[3]
Treatment 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 or adult)[4][5]
- Bicillin L-A <27 kg: 0.6 million units; ≥27 kg: 1.2 million units IM x 1 [4][6]
- Amoxicillin 50 mg/kg once daily (maximum = 1000 mg) for 10 days[7]
Penicillin allergic (mild):
- Cephalexin 20 mg per kg PO BID (maximum 500 mg per dose) x 10 days[8]
- Cefadroxil 30 mg per kg PO QD (maximum 1 g daily) x 10 days[9]
Penicillin allergic (anaphylaxis):[4]
- Clindamycin 7 mg/kg/dose TID (maximum = 300 mg/dose) x 10 days[10]
- Azithromycin 12 mg/kg PO once (maximum = 500 mg), then 6 mg/kg (max=250 mg) once daily for the next 4 days[11]
- Clarithromycin 7.5 mg/kg/dose PO BID (maximum = 250 mg/dose) x 10 days[12]
Steroids
- Single dose of dexamethasone shortens duration of pain
- Dexamethasone 0.6mg/kg PO - maximum of 10 mg
Disposition
- Discharge
See Also
External Links
References
- ↑ 1.0 1.1 Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067.
- ↑ Shulman, ST; Bisno, AL; Clegg, HW; Gerber, MA; Kaplan, EL; Lee, G; Martin, JM; Van Beneden, C (Sep 9, 2012). "Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America.". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 55 (10): e86–102. doi:10.1093/cid/cis629. PMID 22965026.
- ↑ ID society guidelines
- ↑ 4.0 4.1 4.2 Shulman, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2012;55(10):1279–82
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
- ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html