Streptococcal pharyngitis

Background

• Strep pharyngitis
  • Peak in 5-15yr old
  • Rare in <2yr of age
  • Accounts for only 15-30% of pharyngitis

Diagnosis

• Centor Criteria
  • 1. Tonsillar exudates
  • 2. Tender anterior cervical lymphadenopathy
  • 3. Absence of cough
  • 4. History of fever
• 0-1 - strep unlikely, no further testing
• 2-3 - Consider testing
• 4 - Consider treating without testing

Centor Criteria

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

DDx

1. Viral pharyngitis
2. PTA
3. Retropharyngeal abscess
4. EBV pharyngitis
5. CMV pharyngitis
6. Gonococcal pharyngitis

Treatment

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

Antibiotics

• PCN (erythro if allergic)

Clinical Features

• Sore throat
• Painful swallowing
• Fever
• N/V
• Tonsillar exudate

Treatment

• 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
• Steroids
  • Single dose of dexamethasone shortens duration of pain

See Also

• Peritonsilar Abscess

Source

• Tintinalli
• Rosen's