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
...gnosis...
...ldren and adolescents, negative RADT tests sho...
...ive RADTs do not necessitate a back-up culture b...
...e of back up throat cultures for those with a neg...
...ti-streptococcal antibody titers are not...
Testing for GAS pharyngitis usually is not recomm...
...tic studies for GAS pharyngitis are...
Selected children < 3 years old who have oth...
...llow-up post-treatment throat culture or RADT is n...
...testing or empiric treatment of a...
...iologic and Clinical Features of Group A Strept...
...le 2. Microbial Etiology of Acute Ph...
Treatment
...atment...
...ients with acute GAS pharyngitis shou...
...eir narrow spectrum of activity, in...
...ment of GAS pharyngitis in penicillin-...
...anted, use of an analgesic/antipyreti...
...uld be avoided in children. (SR, M)21881...
Adjunctive therapy with a corticosteroid is NO...
...ends that clinicians caring for patients w...
...mmends that identifying GAS carriers is not ordi...
...es NOT recommend tonsillectomy solely to red...
...gure 1. Group A Stretococcal Pharyngitis...
...tibiotic Regimens Recommended for Group A Streptoc...
...nicillin V generic, oral (SR, H)Dose:...
...eneric, oral (SR, H)Dose: 50 mg/kg once dail...
...zathine penicillin G generic, IM (SR, H)Dose:...
...nicillin-Allergic Individuals Cephalexin Kefle...
...xila Duricef®, Ultracef® PO (SR, H)...
...mycin Cleocin® PO (SR, M)Dose: 7 mg/kg...
...cinb Zithromax® PO (SR, M)Dose: 12...
...romycinb Biaxin® PO (SR, M)Dose: 7.5...
...able 4. Treatment Regimens for Chronic GAS Carrier...
...ral Clindamycin Cleocin® (SR, H)Dose: 20-30...
...cillin and Rifampin Rifadin®, Rima...
...oxicillin-clavulanic acid Augmentin®...
IM & Oral Benzathine penicillin G P...