Pharyngitis: Difference between revisions
(Redirected page to Sore throat) |
No edit summary |
||
Line 1: | Line 1: | ||
# | ==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]] | |||
*[[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== | |||
{{Sore throat DDX}} | |||
{{DDX oral rashes and lesions}} | |||
==Evaluation== | |||
===Modified Centor Criteria<ref name=Review09>Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067.</ref>=== | |||
One point is given for each of the criteria:<ref name=Review09/> | |||
#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^ | |||
#*Subtract a point if age >44 | |||
^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>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.</ref> | |||
{| class="wikitable" | |||
|+ Modified Centor score | |||
!Points||Probability of Strep||Management | |||
|- | |||
| 1 or fewer|| <10%||No antibiotic or culture needed | |||
|- | |||
| 2 ||11–17%||rowspan="2"|Antibiotic based on rapid strep or culture | |||
|- | |||
| 3 ||28–35% | |||
|- | |||
| 4 or 5 ||52%||Empiric antibiotics | |||
|} | |||
==Management== | |||
===[[Antibiotics]]=== | |||
{{Streptococcal Pharyngitis Antibiotics}} | |||
===[[Steroids]]=== | |||
*Single dose of [[dexamethasone]] shortens duration of pain<ref>Hayward G, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012 Oct 17;10:CD008268. PMID: 23076943.</ref> | |||
**[[Dexamethasone]] 0.6mg/kg PO - maximum of 10mg | |||
==Disposition== | |||
*Discharge | |||
==See Also== | |||
*[[Sore Throat]] | |||
==References== | |||
<references/> | |||
[[Category:Pediatrics]] | |||
[[Category:ENT]] | |||
[[Category:ID]] |
Revision as of 16:32, 23 January 2017
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
Acute Sore Throat
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [1]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Noninfectious
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Oral rashes and lesions
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Streptococcal pharyngitis
- Tongue diagnoses
- Vincent's angina
Evaluation
Modified Centor Criteria[2]
One point is given for each of the criteria:[2]
- 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^
- Subtract a point if age >44
^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.[3]
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 |
Management
Antibiotics
Treatment can be delayed for up to 9 days and still prevent major sequelae
Penicillin Options:[4]
- 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[5]
Penicillin allergic (mild):[4]
- 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):[4]
- 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[6]
- Dexamethasone 0.6mg/kg PO - maximum of 10mg
Disposition
- Discharge
See Also
References
- ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
- ↑ 2.0 2.1 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.
- ↑ 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
- ↑ 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
- ↑ Hayward G, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012 Oct 17;10:CD008268. PMID: 23076943.