Lecture 8a - Pharyngitis (Strep Throat)

what is the most common cause of Pharyngitis

viruses

what is the main type of bacteria which can cause Pharyngitis

Group A β-hemolytic Streptococcus (S. pyogenes)

how is GABHS transmitted?

direct contact - usually from hands w/ droplets of saliva or nasal secretions

common symptoms of pharyngitis

- sore throat

- fever

- odynophagia aka painful swallowing

- enlarged cervical lymph nodes (anterior swelling)

- scarlatiniform rash

- white patches

scarlet fever

characteristic rash with diffuse erythematous eruption, usually in setting of pharyngitis

rash appears 24-48 hour of sx onset

what are some signs indicative of viral pharyngitis

- rhinorrhea

- cough

- hoarseness

- conjunctivitis

- diarrhea

- oropharyngeal vesicles

How is strep throat diagnosed?

presence of sx and a lab test -- need BOTH

modified cantor score

helps to identify who is indicated for a diagnostic strep test

1 point for each of the following criteria:

- Fever,

- tonsillar or pharyngeal exudate,

- tender anterior cervical lymph nodes,

- absence of cough

+1 = < 15

-1 > 45

0-1 = low risk (testing not indicated)

3-4 = high risk (testing indicated)

what are the different diagnostic tests which can be done to test for strep?

- throat swab for culture (GOLD STANDARD): requires 24-48 hrs for results

- throat swab for RADT: results in mins, POC testing

when are you SUPPOSED to confirm test result from RADT by getting a confirmation culture?

in children/adolescents who have a (-) RADT

what is the role of antibacterial therapy in strep throat

- ↓ severity of symptoms & duration of symptoms (by ~1 day)

- ↓ risk of transmission

- ↓ risk of suppurative complications and rheumatic fever

why might it be reasonable to delay therapy while awaiting throat culture results

- don't affect risk of complications

- GAS pharyngitis is often self-limiting

- delay in antibacterials may ↓ reinfection rates

- unnecessary antibacterial use can be avoided in ~ 50% pts

how long does strep throat typically last

8-10 days

sx may last 2-7 days

what is the antibiotic of choice for treat strep throat and dosing for ...

a) pediatric ≤ 27 kg

b) pediatric > 27 kg

c) adult dose

Penicillin VK x 10 days

a) 300mg BID-TID

b) 600mg BID-TID

c) 600mg BID or 300mg TID

what is another option for treating strep throat in a child who has trouble swallowing pills?

Amoxicillin 50 mg/kg po divided once-twice daily

what are some other possible agents which can be given to treat paediatrics with a penicillin allergy which is

a) non-severe

b) severe/anaphylactic

a) Cephalexin

b) Clindamycin OR

Azithromycin OR

Clarithromycin

* look at notes for dosing*

what are some other possible agents which can be given to treat adults with a penicillin allergy which is

a) non-severe

b) severe/anaphylactic

a)Cefuroxime

b) Clindamycin OR

Azithromycin OR

Clarithromycin

* look at notes for dosing*

what can be offered for symptomatic relief in pharyngitis

- lozenge

- acetaminophen

- ibuprofen

- hydration

when is a follow up culture recommended (3)

- hx rheumatic fever (↑ risk recurrence)

- Persistent symptoms

- Recurrent symptoms