Streptococcal pharyngitis: Difference between revisions
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##[[Retropharyngeal Abscess]] | ##[[Retropharyngeal Abscess]] | ||
##[[Ludwig's Angina]] | ##[[Ludwig's Angina]] | ||
##[[ | ##[[Epiglottitis]] | ||
== Treatment == | == Treatment == |
Revision as of 04:34, 24 November 2011
Background
- Strep pharyngitis
- Peak in 5-15yr old
- Rare in <2yr of age
- Accounts for only 15-30% of pharyngitis
Diagnosis
Clinical Features
- Sore throat
- Painful swallowing
- Fever
- N/V
- Tonsillar exudate
Centor Criteria
- History of fever
- Absence of cough
- Lymphadenopathy
- Tonsillar exudate
DDx
- Causes
- Viral pharyngitis
- Retropharyngeal abscess
- EBV pharyngitis
- CMV pharyngitis
- Gonococcal pharyngitis
- Others
Treatment
Treatment Algorithm by Centor Criteria
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
Treatment Medications
- Abx
- Tx can be delayed for up to 9 days and still prevent major sequelae
- Choices
- Penicillin
- 250mg BID x 10d (child) or 500mg BID x 10d (adolescent)
- Bicillin
- 25-50Kmg/kg IM x 1 (max dose = 1.2million)
- Azithromycin (penicillin allergic)
- 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5
- Penicillin
- Steroids
- Single dose of dexamethasone shortens duration of pain
See Also
Source
- Tintinalli
- Rosen's