Pharyngitis Flashcards
What is the main bacteria behind Pharyngitis?
Group A Beta Hemolytic Streptococcus
- S. Pyogenes
What is Pharyngitis
Infection in Upper Airways (Pharynx)
- Most common is viral
High Risk of Pharyngitis
Children 5-15 years old and those that work with these children
Pharyngitis
- Symptoms
- Sore Throat
- Fever
- Odynophagia (Pain when swallowing)
- Enlarged Lymph Nodes
- Scarlet Fever
Pharyngitis
- Viral Symptoms
- Rhinorrhea
- Cough
- Hoarseness
- Conjunctivitis
- Diarrhea
- Oropharyngeal vesicles (White patches in mouth)
Pharyngitis
- Red Flags
Acute Rheumatic Fever (Inflammatory Response that occurs after 2-3 weeks of untreated Pharyngitis)
- Carditis
- Arthritis
Peritonsillar Abscess or Retropharyngeal Abscess
Otitis Media
Rhinosinusitis
Reactive Arthritis
Pharyngitis
- Diagnosis
Can not diagnosis with just Lab Values or just Symptoms
- Presence of viral symptoms should assess if patient should get testing
- Only test patients with positive microbiologic GABHS tests
Pharyngitis
- Criteria in Modified Centor Score
Used to determine who should get tested for Streptococci Pharyngitis
+ 1 point for fever
+ 1 point for tonsil / pharyngeal exudate
+ 1 point for tender anterior cervical lymph nodes
+ 1 point for absence of cough
+ 1 point if younger than 15 yrs old
- 1 point if older than 45 yrs old
Pharyngitis
- Interpreting Modified Centor Score
0-1 points = Very low risk of strep
3-4 points = Increased risk of strep
Pharyngitis
- Throat Swab
Culture = Gold standard
- Requires 24-48 hours for results
Rapid Antigen Detection Test (RADT) = More practical
If RADT = Positive then no follow up throat culture is needed
If RADT = Negative then confirm diagnosis with a culture (Only for children/adolescents)
Pharyngitis
- Delaying antibacterial therapy
Is reasonable
- Pharyngitis is a self limiting disease, waiting won’t affect risk of complications
- Is better to wait a bit longer to confirm diagnosis to ensure patient does not receive unnecessary antibacterials
Delaying antibacterials can decrease chances of reinfection
Pharyngitis
- Benifits of Antibacterial Therapy
- Decrease risk of transmission
- Decrease risk of suppurative complications and rheumatic fever
- Decreases severity of symptoms and duration of symptoms by 1 day
Pharyngitis
- Treatment
For Adults and Pediatrics:
- Penicillin VK
If suspension is required:
- Amoxicillin Suspension
Pharyngitis (Pediatrics)
- Treatment (Penicillin Allergy)
Non-Severe:
- Cephalexin
Severe
- Clindamycin
- Azithromycin
- Clarithromycin
Pharyngitis (Adults)
- Treatment (Penicillin Allergy)
Cefuroxime
Alternatives:
- Clindamycin
- Azithromycin
- Clarithromycin
Pharyngitis
- Symptomatic Treatment
- Lozenges
- Acetaminophen
- Ibuprofen
- Hydration
Pharyngitis
- Follow Up
Symptoms can last 2-7 days
Follow up generally is not needed
Only follow up if:
- History of rheumatic fever
- Persistient symptoms
- Recurrent symptoms
