Streptococcal pharyngitis: Difference between revisions
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##[[Infectious Mononucleosis|EBV pharyngitis]] | ##[[Infectious Mononucleosis|EBV pharyngitis]] | ||
##CMV pharyngitis | ##CMV pharyngitis | ||
##Gonococcal pharyngitis | ##[[Gonococcal]] pharyngitis | ||
#Others | #Others | ||
##Acute HIV | ##Acute [[HIV]] | ||
##Lemmiere Disease | ##Lemmiere Disease | ||
##[[PTA]] | ##[[PTA]] | ||
| Line 61: | Line 61: | ||
== Treatment == | == Treatment == | ||
* | *[[Antibiotics]] | ||
**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 | ||
**Options: | **Options: | ||
***Penicillin 250mg BID x 10d (child) or 500mg BID x 10d (adolescent) OR | ***[[Penicillin V]] 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent) OR | ||
***Bicillin 25-50Kmg/kg IM x 1 (max dose = 1.2million) | ***[[Bicillin L-A]] 25-50Kmg/kg IM x 1 (max dose = 1.2million) | ||
***PCN allergic (mild): | ***PCN allergic (mild): | ||
****Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d | ****[[Cefuroxime]] 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d | ||
***PCN allergic (anaphylaxis): | ***PCN allergic (anaphylaxis): | ||
****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 19:53, 8 March 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
- Tx can be delayed for up to 9 days and still prevent major sequelae
- Options:
- Penicillin V 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent) OR
- 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
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.