Streptococcal pharyngitis: Difference between revisions
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== Treatment == | == Treatment == | ||
===[[Antibiotics]]<ref> | ===[[Antibiotics]]<ref>[http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-patient_Care/PDF_Library/2012%20Strep%20Guideline.pdf ID society guidelines]</ref>=== | ||
'''Tx can be delayed for up to 9 days and still prevent major sequelae''' | '''Tx can be delayed for up to 9 days and still prevent major sequelae''' | ||
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*[[Clindamycin]] 7.5mg/kg PO QID x 10d (child) or 450mg PO TID x 10d OR | *[[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 | *[[Azithromycin]] 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5 | ||
===Steroids=== | ===Steroids=== | ||
*Single dose of dexamethasone shortens duration of pain | *Single dose of dexamethasone shortens duration of pain | ||
Revision as of 22:51, 3 June 2014
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
- History of fever
- Absence of cough
- Lymphadenopathy
- 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
- Causes
- Viral pharyngitis
- Retropharyngeal abscess
- EBV pharyngitis
- CMV pharyngitis
- Gonococcal pharyngitis
- Others
- Acute HIV
- Lemmiere Disease
- PTA
- Retropharyngeal Abscess
- Ludwig's Angina
- Epiglottitis
Treatment
Antibiotics[1]
Tx can be delayed for up to 9 days and still prevent major sequelae
- Penicillin V 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent)
- Bicillin L-A 25-50Kmg/kg IM x 1 (max dose = 1.2million)
PCN allergic (mild):
- Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d
PCN 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
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.