Pharyngitis Flashcards
Define Pharyngitis
Inflammation in the back of the throat
What are some causes of sore throat?
Allergies
Meds
Irritating substances
Trauma
Tumour
Infection
What biggest cause of pharyngitis?
A virus (rhinovirus)
What are the top three virus that causes pharyngitis?
Rhinovirus
Coronavirus
Influenza
Viral Causes of Acute Pharyngitis
Rhinovirus
Adenovirus
Herpes
Parainfluenza
Coxsackie
Epstein Barr
Influenza A and B
Cytomegalovirus
HIV
What percentage of pharyngitis caused by virus?
Adult and children
80-90 adults
70 children
What percentage of pharyngitis caused by bacteria?
Adult and children
5-15% adult
15-30% sore throats
What amount of adult pt with acute pharyngitis are prescribed?
75%
Why the overuse of antibiotics?
Pt expect them
Pt will see other MD
Pt will not be satisfied without prescription
Quicker to write than explain
Epidemiology of Pharyngitis
Most cases occur during the colder months
Viral usually peak in fall to spring
Strep throat also peaks
Spread within close contacts
What is group A strep?
The only commonly occurring cause of sore throat that antibiotics are indicated
What is the signs and symptoms of Group A?
All cause may have similar
Painful swallowing, exudates, enlarged anterior cervical lymph nodes, fever, increased WBCs, N & V and rash
What is scarlatiniform rash?
It feels like sand paper
Small red bumps
What is the scoring system?
Centro score
What is measured in Centro score?
Age
Exudate/swelling tonsils
Swollen cervical nodes
Temp > 38
No cough
Interpretation of Score
1,0, -1 symptomatic treatment
No RADT, culture
>2 RADT or throat swab for culture
If positive give antibiotics
Ways to diagnosis of GAS pharyngitis
Culture
RADT
Explain details of culture test
Gold standard
>90% sensitivity
May take 1-2 days to get results
Explain the RADT for diagnosis
Takes minutes
+ test = strep throat
Only 70-90% sensitivity
Reasons to Treat
Decrease severity and duration of symptoms
Reduce risk of transmission to others
Reduce complications
Prevent rheumatic heart disease
What is RHD?
Rheumatic heart disease
Heart valve damage (inflammatory response)
What antibiotic can prevent RHD?
Penicillin treatment
What the goal standard for GAP treatment?
Penicillin V
What is the dose and duration for adults and children?
Adults 300 mg TID or 600 mg BID
Ped 40mg/kg/day BID or TID
Duration is 10 days
(Need to be all 10 day)
Benefits of penicillin V
Narrow spectrum of activity
Effective, safe, and cheap
GAS treatment for penicillin allergies
Erythromycin
Ethylksuccinate
Estolate
Clarithromycin
Azithromycin
What is the dose for Eryc?
Dose of 250-500 mg BID to QID
10 days
What is the dose for ethylsuccinate?
40 mg/kg/day given BID to QID
For 10 days
What is the dose for Estolate
40 mg/kg/day given BID to QID
For 10 days
Could you give less days and still have the same effectiveness?
No needs to be all 10 days
What is the dose of clarithromycin?
15 mg/kg/day given BID for 5 days
What dose of azithromycin?
12 mg/kg daily x 5 days
What is the dose for amoxicillin? (adult and children)
Adult 500 mg BID
Peds 40-50 mg/kg/day given daily or BID
For 10 days
Antibiotics used as second line or treatment failures
Cephalosporins (1st / 2nd gen)
Clindamycin
Intramuscular penicillin
Do we treat non-symptomatic pt?
No
It does not need to be treated
What is some examples of symptomatic treatment?
Oral analgesics
Topical analgesics
Lozenges
Gargling with salt water
Fluids
Rest
How long will it take to be non contagious?
24 hours after taking antibiotics
How long should kids stay at home?
24 hours after starting antibiotics and have no fever
What is our Roles?
Make sure an antibiotic is warranted
If Rx for antibiotic is needed
What to do to make sure an antibiotic is warranted?
Educate if not needed - refer if required
Symptomatic treatment
What to do if Rx for antibiotic is needed?
Ensure proper drug, dose, and duration
Counsel pt on the benefits of the drugs
Make pt aware of meaningful side effects
Let pt. Know what to expect
Take aways from pharyngitis
Most sore throats will never need antibiotics
If a pt does have strep throat
Antibiotics are warranted
Need to educated pt
Proper drug, dose, and duration need to be used
