Streptococcal Pharyngitis Diagnosis and Management
Key Points
Key Points
Although acute pharyngitis is one of the most frequent illnesses for which pediatricians and other primary care physicians are consulted, with an estimated 15 million visits per year in the U.S., only a relatively small percentage of patients with acute pharyngitis (20%-30% in children, fewer in adults) are infected by GAS pharyngitis.
Moreover, the signs and symptoms of GAS and nonstreptococcal pharyngitis overlap so broadly that accurate diagnosis on clinical grounds alone is usually impossible.
Accurate diagnosis of streptococcal pharyngitis followed by appropriate antimicrobial therapy is important:
- To prevent acute rheumatic fever with and without carditis
- To prevent suppurative complications (e.g., peritonsillar abscess, cervical lymphadenitis, mastoiditis and possibly other invasive infections)
- To improve clinical symptoms and signs
- For rapid decrease in contagiousness
- To reduce transmission of GAS to family members, classmates, and other close contacts of the patient
- To allow for the rapid resumption of usual activities
- To minimize potential adverse effects of inappropriate antimicrobial therapy.
With the exception of very rare infections by certain other bacterial pharyngeal pathogens (e.g., Corynebacterium diphtheriae and Neisseria gonorrhoeae) (Table 2), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to organisms other than Group A streptococci.
a Unless reaction to a penicillin was anaphylactic.
Diagnosis
...agnosis...
...adolescents, negative RADT tests should b...
...s do not necessitate a back-up culture because th...
...outine use of back up throat cultures...
...cal antibody titers are not recommended in the rou...
...g for GAS pharyngitis usually is not reco...
Diagnostic studies for GAS pharyngitis are not...
...children < 3 years old who have other risk fa...
...ow-up post-treatment throat culture or RADT is...
...ting or empiric treatment of asymp...
...Epidemiologic and Clinical Features of Grou...
...le 2. Microbial Etiology of Acute PharyngitisHavi...
Treatment
...atment...
...s with acute GAS pharyngitis should be treated...
...arrow spectrum of activity, infrequency of adver...
...of GAS pharyngitis in penicillin-al...
...ted, use of an analgesic/antipyretic agent...
...n should be avoided in children. (SR,...
...erapy with a corticosteroid is NOT reco...
...e IDSA recommends that clinicians caring for pa...
The IDSA recommends that identifying GAS carrie...
...T recommend tonsillectomy solely to...
...p A Stretococcal Pharyngitis...
...3. Antibiotic Regimens Recommended for Gr...
...lin V generic, oral (SR, H)Dose: Child...
...cillin generic, oral (SR, H)Dose: 50...
...enicillin G generic, IM (SR, H)Dose:...
For Penicillin-Allergic Individuals Cephal...
...Duricef®, Ultracef® PO (SR, H)Dose: 30 m...
...ndamycin Cleocin® PO (SR, M)Dose: 7 mg/kg/do...
...ycinb Zithromax® PO (SR, M)Dose: 12 mg/...
...arithromycinb Biaxin® PO (SR, M)Dose: 7.5 mg/...
...atment Regimens for Chronic GAS CarriersHavi...
...Clindamycin Cleocin® (SR, H)Dose: 20-30 mg/...
...n and Rifampin Rifadin®, Rimacta...
...ulanic acid Augmentin® (SR, M)Dose: 40 mg a...
...nzathine penicillin G PLUS Rifampin (SR, H)Pen...