Pharyngitis Flashcards
What is pharyngitis?
inflammation in the back of the throat
What are the many causes of sore throats?
allergies
medications (ex: steroid nasal spray)
irritating substance (hot, cold, smoke)
trauma
tumors
infection
What percentage of pharyngitis cases are caused by a virus in adults? What about children?
adults: 80-90%
children: >70%
True or false: pharyngitis is usually not a self-limited disease
false
pharyngitis is usually self-limited
What are the usual causes of pharyngitis?
rhinovirus (most common)
coronavirus
influenza
What are all viral causes of acute pharyngitis?
rhinovirus, coronavirus-common cold
adenovirus-pharyngoconjunctival fever
herpes simplex 1 & 2-pharyngitis, gingivostomatitis
parainfluenzae-cold symptoms, croup
coxsackie A-herpangina, HFM
epstein-barr virus: mononucleosis
influenza A and B-influenza
cytomegalovirus-CMV mononucleosis
HIV-primary HIV infection
True or false: when pharyngitis is bacterial, it is still self-limited
true
What is the most common bacterial cause of pharyngitis in adults?
group A streptococci (5-15%)
What are other bacterial causes of pharyngitis, but dont require treatment?
group C streptococci
group G streptococci
Antibiotics are prescribed in up to __% of adult patients with acute pharyngitis. However, at most __% of cases are bacterial.
75%
20%
What is the epidemiology of pharyngitis?
most cases during winter months (late winter-early spring)
-viral organisms usually peak in fall to spring
-strep also peaks at this time
spread is usually among close contacts with kids being the major reservoir
-may also see “ping-pong spread”
What is the only commonly occurring cause of sore throat that antibiotics are indicated for?
group A strep
What are the signs and symptoms of group A strep infection in the throat?
painful swallowing
exudates
enlarged lymph nodes
fever
increased WBCs
nausea and vomiting (NOT DIARRHEA)
scarlatiniform rash
What are the criteria in the pharyngitis modified centor score?
age 3-14: +1
age 15-45: 0
age >45: -1
exudate or swelling on tonsils: +1
fever (>38): +1
no cough: +1
swollen cervical nodes: +1
How do we interpret the scores of the pharyngitis modified centor score?
-1-0:
-risk of strep infection=2-5%
-symptomatic treatment
-no RADT, no culture, NO ANTIBIOTICS
1:
-risk of strep infection=5-10%
-same as above (symp tx, no RADT, no culture, no ABX)
2:
-risk of strep infection=11-17%
-RADT or throat swab for culture, if + for GAS–>antibiotics
3:
-risk of strep infection=28-36%
-same as above
4:
-risk of strep infection=51-53%
-same as above (consider empiric antibiotics)
What are the two ways to diagnose GAS pharyngitis?
culture (gold standard)
->90% sensitivity, may take 1-2 days for results
rapid antigen detection test (RADT)
-takes minutes, 70-90% sensitivity
True or false: you can diagnose GAS pharyngitis from symptoms alone
false
cannot diagnose from symptoms alone
How long does pharyngitis last if left untreated?
4-5 days
What are the reasons to treat GAS pharyngitis?
decrease severity and duration of symptoms
reduce risk of transmission to others
reduce complications
prevent rheumatic heart disease
When is the best time frame to start antibiotics for GAS pharyngitis? How much does it improvement the healing time frame?
antibiotics started within 2-3 days of symptoms can hasten improvement by 1-2 days
What are the complications of GAS pharyngitis?
peritonsillar abscess
lymph adenitis
otitis media
sinusitis
What is effective treatment for strep pharyngitis in preventing acute rheumatic fever and RHD?
penicillins
What is a rare disease that can develop after GAS pharyngitis infections and cannot be prevented by antibiotics?
post-strep glomerulonephritis
Treatment of GAS pharyngitis must be provided within how many days of onset to prevent acute rheumatic fever?
9 days
What is the DOC for GAS pharyngitis?
penicillin V
-narrow spectrum of activity
-safe, effective, cheap
What is the dosing of PenV in adult for GAS pharyngitis?
300mg TID or 600mg BID
What is the pediatric dosing of PenV for GAS pharyngitis?
40mg/kg/d BID or TID
What is the duration of therapy for GAS pharyngitis?
10 days
True or false: PenV is taken with food
false
should be taken on an empty stomach
Which class of antibiotics have shown efficacy against GAS pharyngitis?
all beta-lactams, so amoxicillin can be used
What is a situation where it would be appropriate to use amoxicillin for GAS pharyngitis?
using the suspension for kids
What is the dosing of amoxicillin in adults for GAS pharyngitis?
500mg BID
What is the dosing of amoxicillin in pediatrics for GAS pharyngitis?
40-50mg/kg/d OD or BID
max 1g/day
What is the dosage regimen of amoxicillin for GAS pharyngitis?
take with food
10 days
What is the DOC for GAS pharyngitis when the patient is allergic to penicillin? What is the dosing of these drugs
macrolides are DOC
erythromycin: 10 days
-base: 250-500mg BID to QID
-ethylsuccinate: 40mg/kg/d BID to QID
-estolate: 40mg/kg/d BID to QID
clarithromycin: 15mg/kg/d BID (max 500mg/d)
azithromycin: 12mg/kg/d x 5 days (max 500mg/d)
What are the second line (or tx failure) antibiotics for GAS pharyngitis?
2nd gen cephalosporin
clindamycin
intramuscular penicillin
True or false: SMX/TMP does not eradicate GAS from the throat
true
What is GAS carriage?
people who carry GAS in the throat with no symptoms
does not require treatment
difficult to separate from viral sore throat
What is the symptomatic treatment for GAS pharyngitis?
oral analgesics
topical analgesics
lozenges
salt water gargle
fluids
rest
