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
Diagno...
...and adolescents, negative RADT tes...
...ive RADTs do not necessitate a back-up cultu...
Routine use of back up throat cultures for t...
...occal antibody titers are not recommended in...
...g for GAS pharyngitis usually is no...
...nostic studies for GAS pharyngitis are...
...d children < 3 years old who have...
...ollow-up post-treatment throat cult...
...ng or empiric treatment of asymptomatic ho...
...ologic and Clinical Features of Group A Streptoco...
...ble 2. Microbial Etiology of Acute...
Treatment
...reatmen...
...atients with acute GAS pharyngitis shou...
...sed on their narrow spectrum of activity, i...
...t of GAS pharyngitis in penicillin-allergi...
...ranted, use of an analgesic/antipyretic agent s...
...uld be avoided in children. (SR, M)21881...
...therapy with a corticosteroid is NO...
...DSA recommends that clinicians caring for patients...
...IDSA recommends that identifying G...
...SA does NOT recommend tonsillectomy solel...
...igure 1. Group A Stretococcal Phary...
Table 3. Antibiotic Regimens Recommended for...
...eric, oral (SR, H)Dose: Children:...
...moxicillin generic, oral (SR, H)Dos...
...athine penicillin G generic, IM (SR,...
...in-Allergic Individuals Cephalexin Keflex® aPO...
...ila Duricef®, Ultracef® PO (SR, H)Dose:...
...indamycin Cleocin® PO (SR, M)Dose: 7 mg/kg...
...ycinb Zithromax® PO (SR, M)Dose:...
...Biaxin® PO (SR, M)Dose: 7.5 mg/kg/dose b...
...ment Regimens for Chronic GAS Carrier...
...lindamycin Cleocin® (SR, H)Dose:...
...lin and Rifampin Rifadin®, Rimactane®...
...avulanic acid Augmentin® (SR, M)Dos...
...ral Benzathine penicillin G PLUS Rifampin (SR, H)P...