ID- GAS pharyngitis Flashcards
What is acute pharyngitis?
Inflammation of mucous membranes of pharynx
- could +/- include tonsils for less than 2 weeks
What is the most common cause of acute pharyngitis (sore throat)? What is the bacteria that causes it?
- virus
Group A strep
What are red flags for referral for GAS pharyngitis
- progressive pain
- unilateral throat pain
- 14+ days of sore throat (should resolve in 1 week)
- stiff neck
- history of ARF/heart valve disease
- Airway obstruction (stridor)
What are symptoms of Bacterial pharyngitis? When does it occur
GAS pharyngitis
occurs in winter or spring
- acute onset
- fever 38+
- mod-severe pain
- redness of pharynx
- swollen/tender lymph nodes
What are symptoms of Viral pharyngitis? When does it occur?
Viral Pharyngitis = all of bacteria +/- :
- cough
- diarrhea
- oral ulcers
- rhinorrhea (runny nose)
- conjunctivitis
Can you sufficiently differentiate between viral and bacterial through history/physical examination?
No
Why not culture every sore throat to see if GAS is present?
If you cultured every sore throat, you can detect GAS in people with viral sore throat and a harmless GAS colonizing in the throat does not need abx
When do you test for GAS?
When centor score is 3+
What are the testing steps for GAS for an adult?
Rapid antigen
- if not available use throat culture
ONLY USE 1
What are testing steps for GAS for a child
Rapid antigen
- if negative confirm with throat culture
When do you NOT do a throat swab in children even if their centor score is 3+?
If they present with a sore throat with
- cough
- rhinitis
- hoarseness
Why do we use antibiotics? What are false reasons?
Reduce risk of complications MAIN REASON
- suppurative and non-suppurative complications
Reduce symptomatology by 16 hours
Does not cure infection
Does not reduce spread
What are suppurative complications of GAS (3)
Characterized by pus, can lead to:
- sinusitis
- otitis media
- peritonsillar abscess
What are non-suppurative complications of GAS (2)
Acute rheumatic fever (can lead to heart disease and death)
- ABX can prevent this
Post-streptococcal glomerulo-nephritis
- ABX does not prevent this
How do you treat if the goal is to decrease symptoms
- consider watchful waiting
Start ABX if: - severe symptoms (centor 3+) not improved or worse after 2-3 days with watchful waiting
How do you treat if the goal is to prevent ARF? What are the risk factors of ARF
Treat if they have risk factors other than AGE
- local prevalence
- residence in indigenous community
- recent immigrant from developing country
- Previous ARF diagnosis
What do you do if patient has a high risk for ARF but centor score is 2?
Throat swab
What type of therapy is GAS
targeted therapy
When should symptoms resolve
10 days
What is the first line treatment choice for GAS? Requirement?
Penicillin V for 10 days
under 27kg = 300mg per dose 2-3 times/day
27kg+ = 600mg per dose 2-3 times/day
No personal history of IgE mediated hypersensitivity
or
Amoxicillin 50mg/kg
What do you give for GAS if children expected to have a difficulty adhering to 10-day ABX
Penicillin G IM
What do you give for GAS if children has a NON-anaphylactic type 1 reaction to penicillin
cephalexin 20mg/kg/dose BID
What do you give for GAS if children has an ANAPHYLACTIC type 1 reaction?
what is the side effect?
Different side chain
What is some symptomatic therapy you can give for pain with or without ABX?
Pain
- Dexamethasone 1 dose for
- tylenol or advil
Throat pain
- benzocaine
How is GAS transmitted? What does this tell us?
Droplets, saliva, or nasal secretions
Testing close contacts not required
Why do we give a 10 day treatment?
To prevent ARF complications
How long should patients take antibiotic if fever and pain symptoms resolve
usually resolves in 7 days
- contact healthcare provider
