Pharyngitis

Question 1

Pharyngitis/Sore throat

Answer 1

Sore throat involves pharyngitis, tonsillitis, laryngitis
Throat swabs and rapid antigen tests shouldn’t be carried out routinely for sore throat
Generally self-limiting with resolution within 2 weeks

Question 2

Causative organisms

Answer 2

Viral most common – approx. 15% bacterial
Bacterial more likely with high fever, tender cervical lymphadenopathy, severe exudative pharyngitis

Viruses
EBV, CMV (mononucleosis/glandular fever)
Adenovirus – pharyngoconjunctival fever
Enteroviruses – herpangina
Bacteria
Beta-haemolytic streptococci – especially group A
Group A strep can be associated with rheumatic fever and glomerulonephritis – seek expert advice
Anaerobes – fusobacteria sp.

Question 3

Symptoms/signs

Answer 3

Sore throat
Dysphagia/odynophagia
Swollen tonsils
Palatal petechiae

NB: petechial rash, strawberry tongue – scarlet fever (notifiable) – SEEK EXPERT ADVICE

Question 4

Management

Answer 4

Paracetamol/ibuprofen for symptomatic treatment
Antibiotics not routinely indicated
PO penicillin V 500mg QDS or clarithromycin 500mg BD for suspected streptococcal (NB treat for 10 days to eradicate carriage)
Some evidence of single dose oral corticosteroid to reduce severity/duration of pain – not yet incorporated into UK guidelines

NICE guidelines for antibiotics:
Features of marked systemic upset secondary to acute sore throat
Unilateral peritonsillitis
History rheumatic fever
Increased risk acute infection e.g. diabetes or immunodeficiency
Patient with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria present (which indicates Strep A infection)
Presence tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough
If indicated then either phenoxymethylpenicillin or clarithromycin/erythromycin (if penicillin allergy) – 7 or 10 day course