Streptococcal pharyngitis: Difference between revisions

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[[File:StrepPhar.jpeg|thumbnail]]
[[File:StrepPhar.jpeg|thumbnail]]


==Diagnosis - Centor Criteria==
==Diagnosis==
#History of fever
===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>==
#Absence of cough
One point is given for each of the criteria:<ref name=Review09/>
#Lymphadenopathy
*Absence of a cough
#Tonsillar exudate or swelling
*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
|-
|-
| '''Points'''
| 1 or fewer|| <10%||No antibiotic or culture needed
| '''Treatment'''
|'''Likeilihood of Strep'''
|-
|-
| 4
| 2        ||11–17%||rowspan="2"|Antibiotic based on rapid strep or culture
| Rx without testing
| 50% PPV
|-
|-
| 3
| 3       ||28–35%
| Rapid Strep Test
| 40% PPV
|-
|-
| 2
| 4 or 5  ||52%||Empiric antibiotics
| Rapid Strep Test
|
|-
| 1
| Do not test/treat
|
|-
| 0
| Do not test/treat
| 80% NPV
|}
|}
*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
StrepPhar.jpeg

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)
Modified Centor score
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

Others

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

Complications

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. 1.0 1.1 Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067.
  2. Cite error: Invalid <ref> tag; no text was provided for refs named IDSA2012
  3. ID society guidelines
  4. 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
  5. 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