Streptococcal pharyngitis: Difference between revisions
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[[File:StrepPhar.jpeg|thumbnail]] | [[File:StrepPhar.jpeg|thumbnail]] | ||
==Diagnosis | ==Diagnosis== | ||
===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 >{{convert|38.0|C|F}} | |||
*Tonsillar exudate or swelling | |||
*Age less than 15 (a point is subtracted if age >44) | |||
{| class="wikitable" | {| 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 | | 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.<ref name=IDSA2012/> | |||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 17:39, 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:[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
- 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
- ↑ 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