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
- History of fever
- Absence of cough
- Lymphadenopathy
- Tonsillar exudate or swelling
| Points | Treatment | Likeilihood of Strep |
| 4 | Rx without testing | 50% PPV |
| 3 | Rapid Strep Test | 40% PPV |
| 2 | Rapid Strep Test | |
| 1 | Do not test/treat | |
| 0 | Do not test/treat | 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[1]
Treatment can be delayed for up to 9 days and still prevent major sequelae
Penicillin Options:[2]
- Penicillin V 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent or adult)
- Bicillin L-A <27 kg: 0.6 million units; ≥27 kg: 1.2 million units IM x 1
- Amoxicillin 500-875 mg PO q12h or 250-500 PO q8h for 10d[3]
Penicillin allergic (mild):[2]
- Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d
- Cefixime 400mg/day PO in single daily dose x10d or divided q12hr x10d
Penicillin allergic (anaphylaxis):[2]
- 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
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.
- ↑ ID society guidelines
- ↑ 2.0 2.1 2.2 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
- ↑ Shah, U. K., MD. (2020, October 14). Tonsillitis and Pharyngitis Organism-Specific Therapy: Specific Organisms and Therapeutic Regimens. Emedicine. https://emedicine.medscape.com/article/2011872-overview