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

DDx

1. Causes
   1. Viral pharyngitis
   2. Retropharyngeal abscess
   3. EBV pharyngitis
   4. CMV pharyngitis
   5. Gonococcal pharyngitis
2. Others
   1. Acute HIV
   2. Lemierre's Syndrome
   3. PTA
   4. Retropharyngeal Abscess
   5. Ludwig's Angina
   6. Epiglottitis

Treatment

Antibiotics

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)
• 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

Penicillin allergic (mild):

• 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):

• 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.