Streptococcal pharyngitis: Difference between revisions
No edit summary |
|||
| Line 27: | Line 27: | ||
#Gonococcal pharyngitis | #Gonococcal pharyngitis | ||
== Treatment == | == Treatment == | ||
===Treatment Algorithm by Centor Criteria=== | |||
{| | === Treatment Algorithm by Centor Criteria === | ||
{| cellspacing="1" cellpadding="1" border="1" style="width: 333px; height: 129px;" | |||
|- | |- | ||
| '''Points'''<br | | '''Points'''<br> | ||
| '''Treatment'''<br | | '''Treatment'''<br> | ||
|- | |- | ||
| 4<br | | 4<br> | ||
| Rx without testing | | Rx without testing | ||
|- | |- | ||
| 3<br | | 3<br> | ||
| Rapid Strep Test | | Rapid Strep Test | ||
|- | |- | ||
| 2<br | | 2<br> | ||
| Rapid Strep Test | | Rapid Strep Test | ||
|- | |- | ||
| 1<br | | 1<br> | ||
| Do not test/treat | | Do not test/treat | ||
|- | |- | ||
| 0<br | | 0<br> | ||
| Do not test/treat | | Do not test/treat | ||
|} | |} | ||
*Likelihood of streptococcal pharyngitis in pts presenting with sore throat | |||
**4 criteria = 50% PPV | *Likelihood of streptococcal pharyngitis in pts presenting with sore throat | ||
**3 criteria = 40% PPV | **4 criteria = 50% PPV | ||
**3 criteria = 40% PPV | |||
**0 criteria - 80% NPV | **0 criteria - 80% NPV | ||
===Treatment Medications=== | === Treatment Medications === | ||
*Abx | |||
**Tx can be delayed for up to 9 days and still prevent major sequelae | *Abx | ||
**Choices | **Tx can be delayed for up to 9 days and still prevent major sequelae | ||
***Penicillin | **Choices | ||
****250mg BID x 10d (child) or 500mg BID x 10d (adolescent) | ***Penicillin | ||
***Bicillin | ****250mg BID x 10d (child) or 500mg BID x 10d (adolescent) | ||
****25-50Kmg/kg IM x 1 (max dose = 1.2million) | ***Bicillin | ||
***Azithromycin (penicillin allergic) | ****25-50Kmg/kg IM x 1 (max dose = 1.2million) | ||
****12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5 | ***Azithromycin (penicillin allergic) | ||
*Steroids | ****12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5 | ||
*Steroids | |||
**Single dose of dexamethasone shortens duration of pain | **Single dose of dexamethasone shortens duration of pain | ||
Revision as of 04:28, 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
- Viral pharyngitis
- PTA
- Retropharyngeal abscess
- EBV pharyngitis
- CMV pharyngitis
- Gonococcal pharyngitis
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