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...
...children and adolescents, negativ...
...ositive RADTs do not necessitate a back...
...outine use of back up throat cultures for thos...
...i-streptococcal antibody titers are not recom...
...GAS pharyngitis usually is not recommend...
...udies for GAS pharyngitis are not indica...
...children < 3 years old who have other risk facto...
...treatment throat culture or RADT is not recom...
...testing or empiric treatment of asymptomatic house...
Table 1. Epidemiologic and Clinica...
...al Etiology of Acute PharyngitisHaving troub...
Treatment
...Treatment...
...with acute GAS pharyngitis should be treat...
Based on their narrow spectrum of activity, in...
...f GAS pharyngitis in penicillin-allergic indiv...
...f warranted, use of an analgesic/antipyretic agen...
...hould be avoided in children. (SR, M)21881...
...junctive therapy with a corticosteroid is N...
...ends that clinicians caring for patients w...
...ecommends that identifying GAS carriers is not...
...oes NOT recommend tonsillectomy sole...
...roup A Stretococcal Pharyngit...
...ntibiotic Regimens Recommended for Gr...
...V generic, oral (SR, H)Dose: Childre...
...illin generic, oral (SR, H)Dose: 50 mg/kg once...
Benzathine penicillin G generic, IM (...
...llergic Individuals Cephalexin Keflex® aPO (...
...fadroxila Duricef®, Ultracef® PO...
...leocin® PO (SR, M)Dose: 7 mg/kg...
...thromycinb Zithromax® PO (SR, M)D...
...romycinb Biaxin® PO (SR, M)Dose: 7.5...
...able 4. Treatment Regimens for Chronic GAS...
...indamycin Cleocin® (SR, H)Dose:...
Penicillin and Rifampin Rifadin®, Rim...
...oxicillin-clavulanic acid Augmentin® (SR, M)D...
...enzathine penicillin G PLUS Rifampin (...