Strep Throat 2021

Question 1

3 Suppurative complications of GAS pharyngitis

Answer 1

Peritonsillar abscess
Retropharyngeal abscess
Sepsis

Question 2

2 non-suppurative complications of GAS pharyngitis

Answer 2

Post-strep glomerulonephritis

Acute rheumatic fever

Question 3

Acute rheumatic fever sequelae and how it is diagnosed

Answer 3

Can cause irreversible damage to the heart valves

Diagnosed using revised Jones criteria

Question 4

Why do we use antibiotics to treat GAS pharyngitis?

Answer 4

Prevents suppurative complications and acute rheumatic fever

Does not prevent post-strep GN

Question 5

Signs and symptoms of GAS pharyngitis (FACTS mneumonic)

Answer 5

Fever >38 degrees
Anterior cervical lymphadenopathy (tender)
Absence of cough and rhinorrhea
Inflamed and/or purulent tonsils
Moderate to severe sore throat

Question 6

Gold standard diagnosis of GAS pharyngitis

Answer 6

Bacterial culture from a swab of the tonsils and posterior pharyngeal wall

Question 7

Should anti-streptolysin O titer (ASOT) be used to diagnose GAS pharyngitis?

Answer 7

Nope!

It cannot distinguish GAS carriage from active infection

Question 8

CENTOR clinical decision rule

Answer 8

Only for children 3-14 years old
One point for each of: exudate or swollen tonsils, tender or swollen anterior nodes, fever, no cough
If total score is 3 or higher, do a throat swab

Question 9

Treatment of GAS pharyngitis

Answer 9

Treatment is indicated within 9 days of onset
Optimal treatment is penicillin or amoxicillin for 10 days
If allergic to penicillins, can give azithro, carithro, or clinda
Tylenol or ibuprofen for symptom management
NO dexamethasone

Question 10

Dosing for GAS pharyngitis

1. Penicillin V (<27 kg)
2. Penicillin V (>27 kg)
3. Amoxicillin
4. Penicillin G benzathine IM (children with difficulty adhering to 10d course of antibiotics)

Answer 10

1. 300mg per dose PO, 2-3 times per day
2. 600mg per dose PO, 2-3 times daily
3. 50mg/kg PO daily, 1g max daily
4. <27kg = 600,000 units or >27kg = 1,200,000 units

Question 11

How fast should GAS pharyngitis improve? What about if it is viral pharyngitis with incidental GAS carriage?

Answer 11

Rapid clinical improvement in <24 hours

Viral infection with incidental GAS improves more gradually, over 2-3 days