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
...gnosis
...and adolescents, negative RADT tests should be...
...RADTs do not necessitate a back-up...
...ine use of back up throat cultures for those wit...
...nti-streptococcal antibody titers are not r...
...g for GAS pharyngitis usually is not recommended...
...tic studies for GAS pharyngitis are not indicated...
...d children < 3 years old who have o...
...reatment throat culture or RADT is...
...ing or empiric treatment of asymptomatic household...
...e 1. Epidemiologic and Clinical Featu...
...le 2. Microbial Etiology of Acute Pha...
Treatment
...eatment...
Patients with acute GAS pharyngitis should be tr...
...on their narrow spectrum of activity,...
Treatment of GAS pharyngitis in penicillin-allerg...
...ed, use of an analgesic/antipyretic agen...
Aspirin should be avoided in childr...
...tive therapy with a corticosteroid is NO...
...A recommends that clinicians caring for...
...e IDSA recommends that identifying GAS carriers i...
The IDSA does NOT recommend tonsillectomy s...
...Group A Stretococcal Pharyngitis...
...le 3. Antibiotic Regimens Recommended for Gro...
...n V generic, oral (SR, H)Dose: C...
...illin generic, oral (SR, H)Dose: 50 mg/kg...
...penicillin G generic, IM (SR, H)Dose:...
...n-Allergic Individuals Cephalexin Keflex® aPO (...
...icef®, Ultracef® PO (SR, H)Dose: 30 mg/k...
...eocin® PO (SR, M)Dose: 7 mg/kg/dose tid (...
...Zithromax® PO (SR, M)Dose: 12 mg/kg daily (M...
...nb Biaxin® PO (SR, M)Dose: 7.5 mg/kg/dose...
...e 4. Treatment Regimens for Chronic GAS...
...ycin Cleocin® (SR, H)Dose: 20-30 m...
...icillin and Rifampin Rifadin®, Rima...
...n-clavulanic acid Augmentin® (SR,...
...hine penicillin G PLUS Rifampin (SR, H)Penicillin...