Pharyngitis Flashcards
What is pharyngitis?
Inflammation in the back of the throat
What are the causes of sore throat and is sore throat common?
Allergies
Medications
Irritating substances (hot, cold, smoke)
Trauma
Tumors
Infxn
1-2% of all doctor visits
What is the most common cause of pharyngitis?
Rhinovirus
Is pharyngitis mainly caused by a virus or a bacteria? Explain
Mainly caused by a virus (80-90% of adults ; >70% of children)
There is no need for antimicrobial tx
Tx sx if bothersome
Self-limiting (resolves by itself)
usually rhinovirus, coronavirus, or influenza
Provide examples of viruses and what conditions that they may cause
Rhinovirus, coronavirus, - common cold
Adenovirus - pharyngoconjunctival fever (red eyes, throat fever)
herpes simplex type 1 and 2 - pharyngitis, gingivostomatitis
Parainfluenza - cold sx, croup
Coxsakie A - herpangina, HFM disease
Epstein-Barr virus - infectious mononucleosis
Influenza A and B - influenza
Cytomegalovirus - CMV mononucleosis
HIV - primary HIV infxn
Explain the bacteria causes of Pharyngitis in adults and children
In adults: 5-15% causes are caused by Group A b-hemolytic streptococci (GAS)
In children 15-30% of sore throats are from GAS
Bacterial causes are still self-limiting
True or False: Group C and group G streptococci can also cause sore throat, which requires treatment
Yes, they can cause sore throat
They don’t require treatment
Why are antibiotics overused in pharyngitis?
Pt expect them
Pt will see other MD’s if they don’t get them
Pt will not be satisfied w/o a Rx
Faster to write a Rx than to explain why one is not needed
True or False: antibiotics are not overused in pharyngitis cases
False
What time of the year does strep throat occur the most?
During the colder months - late winter and early spring (the same as respiratory disease season)
Viral orgs and strep throat peak in the fall to the spring
How is strep throat spread?
Spread among close contacts
Common in families -> kids are the major reservoir (ping-pong spread)
What is the only group of bacteria that we should give ABs to for strep throat?
Group A strep (GAS)
What are the signs and symptoms of Group A strep pharyngitis?
Signs and sx may vary widely
Painful swallowing
Exudate
Enlarged anterior cervical lymph nodes
Fever
Increased WBCs
Nausea and vomiting (NOT diarrhea unless its viral)
Scarlatiniform rash
Explain a scarlatiniform rash
A blushy, fine rash with a sandpaper feel
Explain the criteria (7) for the modified centor scoring for GAS
Age 3-14: +1
Age 15-44: 0
Age 45+: -1
Exudate or tonsil swelling: +1
Swollen anterior cervical nodes: +1
Temp 38+ (oral): +1
No cough: +1
Based on the Centor scoring system, what scores warrant a RADT? How about empiric AB tx?
2+ for RADT (can also use a throat swab +culture)
4+ for AB tx (but still only around 50% sure its strep)
What scores warrant symptomatic tx?
1,0,-1 No RADT, but culture or AB needed
What are the gold standards for GAS strep diagnosis? What are the differences between them?
- Culturing, 90+ sensitivity
May take 1-2 days to get results - Rapid antigen detection test (RADT)
Takes minutes
Positive means strep throat
Only 70-90% sensitivity
How long does strep throat last untreated?
4-5 days
What are the 4 main reasons to treat strep throat?
To get rid of sore throat
To reduce transmission to others
To reduce complications
To prevent rheumatic heart disease
What does AB therapy accomplish in pt with GAS strep throat?
Treats the bothersome sx
If AB started w/in 2-3 days, then sx can improve sx by 1-2 days
Explain AB tx for GAS strep throat from a transmission perspective
Just 24hrs of AB therapy greatly reduces the recovery of GAS from pharyngeal cultures
Prevents the ping pong effect
What are the complications of GAS strep throat?
Peritonsillar abscess, lymph adenitis, otitis media, sinusitis, etc
All have low incidence, but still
What is rheumatic heart disease? How soon must GAS be treated to prevent it?
Heart valve damage due to the bacteria causing inflammation and destruction of the heart valves
9 days
What is post-strep glomerulonephritis? What is significant about it?
Severe kidney dialysis, can cause a child to be on dialysis
this condition is not prevented by anitbiotics
What is the incidence of acute rheumatic fever in Canadian and First Nation children? Why is it higher in FN?
CAD: 0.3/100,000
FN: 21.3/100,000
Due to limited access to health care and poor living conditions
What is the DOC for GAS? Why?
penicillin V
narrow spectrum of activity
Effective, safe, cheap -> and prevents RHD
MIC is very low, so a low concentration is v. effective
What is the dosing of Pen V for adults and children with GAS?
Adults = 300mg TID or 600mg BID
Pediatrics: 40mg/kg/day BID or TID
Duration is 10d (full course needed for RHD prevention)
Preferably on empty stomach
What is the rate of penicillin resistance with GAS?
0%
Explain the GAS treatment for beta-lactam agents such as amoxicillin
Appropriate in kids, but tastes v. bad, so suspensions are available
Adults: 500mg BID
Pediatrics: 40-50mg/kg/day given OD or BID (max 1g/d)
Duration of 10 days
May be taken with meals
What do we give to patients with GAS who have a penicillin allergy?
Macrolides (erythromycin) are the DOC
Erythromycin base: 250-500mg BID to QID
Ethylsuccinate: 40mg/kg/day BID to QID
Estolate: 40mg/kg/day BID to QID
Duration of 10 days
Clarithromycin: 15mg/kg/day BID (max 500mg/d)
Azithromycin: 12 mg/kg daily x5 days (max 500mg/d)
What is the rate of erythromycin resistance with GAS?
15%+
What are the ABs that are used 2nd line or if treatment fails?
Cephalosporins (1st and 2nd gen)
Clindamycin
Intramuscular penicillin
Does TMP/SMX eradicate GAS from the throat?
No
What is the symptomatic treatment for GAS strep throat?
Oral analgesics (for pain management)
Topical analgesics (very short acting)
Lozenges (soothing)
Gargling with salt water (avoid use in ppl with salt restriction)
Fluids
Rest
How long does it take after AB are given to prevent transmission of GAS strep?
24 hours
What to do as a pharmacist if the patient does have strep throat? (general)
AB are warranted
Pt needs to be educated
Proper drug, does, duration need to be used
