Streptococcal pharyngitis

Streptococcal pharyngitis - Acute
Rahul Soman, M. Pharm

 

Definition  

Throat infection caused by group A beta-hemolytic streptococcus (GABHS)

 

Medical History  

* Exposure to Streptococcal Pharyngitis

 

Findings  

* Abdominal pain - Acute

* Cervical lymphadenopathy

* Erythema scarlatiniforme

* Exudate on tonsils

* Fever

* Fever

* Headache

* Nausea and vomiting - Acute

* Pain in throat

* Petechiae

* Pharyngeal erythema

 

Tests  

 

Suspected group A beta-hemolytic streptococcal throat infection  

* Microbial identification kit, rapid strep method: In the presence of concordant signs and symptoms, a positive rapid antigen detection test (RADT) is diagnostic for group A beta-hemolytic streptococcus infection in adults and children .

 

Confirmation of suspected streptococcal pharyngitis in children and adolescents with a negative antigen-detection (rapid strep) test  

* Throat culture: Throat culture is the gold standard for the diagnosis of group A beta-hemolytic streptococcus pharyngitis .

 

Suspected streptococcal pharyngitis in adults  

* Throat culture: Throat cultures are not recommended for the routine, primary evaluation of adults with suspected streptococcal pharyngitis .

 

Differential Diagnosis  

* Viral pharyngitis

* Infectious mononucleosis - Acute

* Gonorrhea of pharynx

* Mycoplasmal pharyngitis

* Diphtheria - Acute

* Epiglottitis - Acute

* Chlamydial pharyngitis

* Peritonsillar abscess - Acute

* Herpes simplex - Acute

* Ludwig's angina - Acute

* Bacterial pharyngitis, acute

 

Treatment  

 

Drug Therapy  

 

 

Streptococcal pharyngitis  

 

PENICILLIN V POTASSIUM  

Adults: 250 mg orally three to four times daily, or 500 mg orally twice daily, for 10 days

Children: 250 mg orally three to four times daily for 10 days

 

PENICILLIN G BENZATHINE  

Adults: 1.2 million units IM once

Children: 25,000 units/kg IM once (maximum 1.2 million units)

 

ERYTHROMYCIN  

Adults: 250 mg orally four time daily for 10 days

Children: 20-40 mg/kg/day orally in 2-4 divided doses for 10 days (maximum 1 gm/day)

 

AZITHROMYCIN  

Adults: 500 mg orally once on day 1, then 250 mg orally once daily for 4 days

Children: 10 mg/kg orally once on day 1 (maximum 500 mg), then 5 mg/kg orally once daily for 4 days (maximum 250 mg)

 

CEFUROXIME SODIUM  

Adults: 250 mg orally twice daily for 5-7 days

Children: 10 mg/kg orally twice daily for 5-7 days (maximum 500 mg/day)

 

 

Fever  

 

ACETAMINOPHEN (Related toxicological information in ACETAMINOPHEN-ACUTE, ACETAMINOPHEN-REPEATED SUPRATHERAPEUTIC)  

Adults: 650 to 1,000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed

 

IBUPROFEN (Related toxicological information in IBUPROFEN)  

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

Pediatrics: 5 to 10 mg/kg orally every 6 to 8 hours as needed (maximum, lesser of 40 mg/kg/day or 2.4 g/day)

 

Procedural Therapy  

 

Recurrent, symptomatic streptococcal pharyngitis  

* Tonsillectomy: Tonsillectomy may be indicated in patients with recurrent, symptomatic episodes of streptococcal pharyngitis .