Streptococcal pharyngitis

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

Diagnosis - Centor Criteria

1. History of fever
2. Absence of cough
3. Lymphadenopathy
4. Tonsillar exudate or swelling

DDx

1. Causes
   1. Viral pharyngitis
   2. Retropharyngeal abscess
   3. EBV pharyngitis
   4. CMV pharyngitis
   5. Gonococcal pharyngitis
2. Others
   1. PTA
   2. Retropharyngeal Abscess
   3. Ludwig's Angina
   4. Epiglottitis

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)
    • PCN Allergic
      • Cephalosporin (e.g.: Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d)
      • If hx of PCN anaphylaxis: clindamycin 7.5mg/kg PO QID x 10d (child) or 450mg PO TID x 10d
      • Azithromycin 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5 [resistance rates as high as 15% in US]
• Steroids
  • Single dose of dexamethasone shortens duration of pain

See Also

• Peritonsilar Abscess

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.