Streptococcal pharyngitis

Background

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

DDx

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

Diagnosis

Clinical Features

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

Centor Criteria

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

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
• Steroids
  • Single dose of dexamethasone shortens duration of pain

See Also

• Peritonsilar Abscess

Source

• Tintinalli
• Rosen's