Streptococcal pharyngitis: Difference between revisions
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*Temperature >{{convert|38.0|C|F}} | *Temperature >{{convert|38.0|C|F}} | ||
*Tonsillar exudate or swelling | *Tonsillar exudate or swelling | ||
*Age less than 15 (a point is subtracted if age >44) | *Age less than 15 (a point is subtracted if age >44)^ | ||
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^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.<ref name=IDSA2012/> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 17:40, 1 March 2015
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
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 >Template:Convert
- 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]
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[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]
Pediatric Dosing:
- Amoxicillin 50mg/kg PO once daily x 10 days (max 1000mg)
- Penicillin V <27kg: 250mg PO BID-TID x 10 days; >27kg: 500mg PO BID-TID x 10 days
- Penicillin G Benzathine <27kg: 600,000 units IM x 1; >27kg: 1.2 million units IM x 1
- PCN allergy (mild): Cephalexin 20mg/kg PO BID x 10 days (max 500mg/dose)
- PCN allergy (mild): Cefadroxil 30mg/kg PO daily x 10 days (max 1g)
- PCN allergy (severe): Azithromycin 12mg/kg PO day 1 (max 500mg), then 6mg/kg daily x 4 days (max 250mg)
- PCN allergy (severe): Clindamycin 7mg/kg/dose PO TID x 10 days (max 300mg/dose)
- PCN allergy (severe): Clarithromycin 7.5mg/kg PO BID x 10 days (max 250mg/dose)
- Clindamycin 7mg/kg/dose PO q8h x 10 days[13]; Max: 300mg/dose
- Azithromycin Children ≥2 years and Adolescents: Oral: 12mg/kg/dose once daily for 5 days (maximum: 500mg daily)
- Amoxicillin 50mg/kg PO q24h x 10 days[14]; Max: 1000mg/day
- Clarithromycin >6mo: 15mg/kg/day PO divided q12h x 7-10d
- Cephalexin 40mg/kg/day PO divided q12h x 10 days; Max: 500mg/dose
- Cefpodoxime 100mg q 12 h for 5-10 days
- Cefuroxime 250mg PO bid x10 days
- Cefuroxime 250mg PO bid x10 days
Steroids
- Single dose of dexamethasone shortens duration of pain
- Dexamethasone 0.6mg/kg PO
Complications
- Acute rheumatic fever
- Scarlet fever
- Streptococcal toxic shock syndrome
- Post-Streptococcal Glomerular Nephritis (PSGN)
- PANDAS syndrome
- Peritonsillar abscess
- Cervical lymphadenitis
- Mastoiditis
See Also
External Links
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.
- ↑ 1.0 1.1 Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067.
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedIDSA2012 - ↑ 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
- ↑ 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