Difference between revisions of "Streptococcal pharyngitis"

(Steroids)
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===Steroids===  
 
===Steroids===  
 
*Single dose of [[dexamethasone]] shortens duration of pain
 
*Single dose of [[dexamethasone]] shortens duration of pain
**[[Dexamethasone]] 0.6mg/kg PO with a maximum of 10 mg
+
**[[Dexamethasone]] 0.6mg/kg PO - maximum of 10 mg
  
 
==Disposition==
 
==Disposition==

Revision as of 01:41, 20 October 2015

Background

  • Strep pharyngitis
    • Peak in 5-15yr old
    • Rare in <2yr of age
    • Accounts for only 15-30% of pharyngitis
culture positive strep pharyngitis with typical tonsillar exudate

Clinical Features

  • Sore throat
  • Painful swallowing
  • Fever
  • N/V
  • Tonsillar exudate
  • Palatal petechiae

Complications

Differential Diagnosis

Pharyngitis

Others

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 >38.0 °C (100.4 °F)
  • 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]

Management

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

Penicillin allergic (mild):[4]

  • Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d

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

Disposition

  • Discharge

See Also

External Links

References

  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. 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.
  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