Streptococcal Pharyngitis Diagnosis and Management
Key Points
Key Points
Although acute pharyngitis is one of the most frequent illnesses for which pediatricians and other primary care physicians are consulted, with an estimated 15 million visits per year in the U.S., only a relatively small percentage of patients with acute pharyngitis (20%-30% in children, fewer in adults) are infected by GAS pharyngitis.
Moreover, the signs and symptoms of GAS and nonstreptococcal pharyngitis overlap so broadly that accurate diagnosis on clinical grounds alone is usually impossible.
Accurate diagnosis of streptococcal pharyngitis followed by appropriate antimicrobial therapy is important:
- To prevent acute rheumatic fever with and without carditis
- To prevent suppurative complications (e.g., peritonsillar abscess, cervical lymphadenitis, mastoiditis and possibly other invasive infections)
- To improve clinical symptoms and signs
- For rapid decrease in contagiousness
- To reduce transmission of GAS to family members, classmates, and other close contacts of the patient
- To allow for the rapid resumption of usual activities
- To minimize potential adverse effects of inappropriate antimicrobial therapy.
With the exception of very rare infections by certain other bacterial pharyngeal pathogens (e.g., Corynebacterium diphtheriae and Neisseria gonorrhoeae) (Table 2), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to organisms other than Group A streptococci.
a Unless reaction to a penicillin was anaphylactic.
Diagnosis
...Diagnosis...
...hildren and adolescents, negative R...
...o not necessitate a back-up culture beca...
...utine use of back up throat cultures...
...reptococcal antibody titers are not reco...
...or GAS pharyngitis usually is not recommen...
...ostic studies for GAS pharyngitis are not in...
...en < 3 years old who have other risk factor...
...ollow-up post-treatment throat culture or RA...
...ing or empiric treatment of asymptom...
...ologic and Clinical Features of Group A Str...
Table 2. Microbial Etiology of Acute...
Treatment
...with acute GAS pharyngitis should be treated...
...narrow spectrum of activity, infrequency of adve...
...ent of GAS pharyngitis in penicilli...
...nted, use of an analgesic/antipyretic...
...pirin should be avoided in children. (SR, M)21881...
Adjunctive therapy with a corticosteroid is NOT r...
...A recommends that clinicians caring for patie...
...recommends that identifying GAS carrier...
...s NOT recommend tonsillectomy solely to reduc...
.... Group A Stretococcal Pharyngitis...
...Antibiotic Regimens Recommended f...
...generic, oral (SR, H)Dose: Children: 2...
...icillin generic, oral (SR, H)Dose: 50...
...ne penicillin G generic, IM (SR, H)Dose: < 2...
...lin-Allergic Individuals Cephalexin Kefl...
Cefadroxila Duricef®, Ultracef® P...
...ocin® PO (SR, M)Dose: 7 mg/kg/dose tid...
Azithromycinb Zithromax® PO (SR, M)Dose: 12...
...thromycinb Biaxin® PO (SR, M)Dose: 7.5 m...
Table 4. Treatment Regimens for Chronic...
...mycin Cleocin® (SR, H)Dose: 20-30 mg/kg/d3...
...in and Rifampin Rifadin®, Rimactan...
...avulanic acid Augmentin® (SR, M)Dos...
...zathine penicillin G PLUS Rifampin (SR, H)Peni...