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
Diagnos...
...en and adolescents, negative RADT tests sh...
...o not necessitate a back-up culture because they a...
...ack up throat cultures for those with a n...
...occal antibody titers are not reco...
...esting for GAS pharyngitis usually is not recom...
...c studies for GAS pharyngitis are not i...
...en < 3 years old who have other risk factors suc...
...ost-treatment throat culture or RADT is not r...
...ic testing or empiric treatment of asym...
...le 1. Epidemiologic and Clinical Features...
...icrobial Etiology of Acute Pharyngit...
Treatment
...eatment...
...with acute GAS pharyngitis should be treated with...
...ased on their narrow spectrum of activity, i...
...t of GAS pharyngitis in penicillin-allergic i...
...anted, use of an analgesic/antipyretic agent suc...
...in should be avoided in children. (SR,...
...herapy with a corticosteroid is NOT recommend...
...mmends that clinicians caring for pa...
...mmends that identifying GAS carriers is not ordin...
The IDSA does NOT recommend tonsille...
...re 1. Group A Stretococcal Pharyngitis...
...iotic Regimens Recommended for Group...
...V generic, oral (SR, H)Dose: Children: 250...
...eneric, oral (SR, H)Dose: 50 mg/k...
...icillin G generic, IM (SR, H)Dose: < 27...
...icillin-Allergic Individuals Cepha...
...fadroxila Duricef®, Ultracef® PO (SR, H)Dose:...
...Cleocin® PO (SR, M)Dose: 7 m...
...ycinb Zithromax® PO (SR, M)Dose:...
...ycinb Biaxin® PO (SR, M)Dose: 7.5 mg/kg/...
...Treatment Regimens for Chronic GAS...
...ndamycin Cleocin® (SR, H)Dose: 20-...
...Rifampin Rifadin®, Rimactane® (SR, H)Dose:...
...in-clavulanic acid Augmentin® (SR, M)...
...Benzathine penicillin G PLUS Rifampin (SR,...