Contents

Search

streptococcal pharyngitis (strep throat)

See pharyngitis &/or group A beta-hemolytic streptococcus Clinical manifestations: 1) also see pharyngitis 2) features suggestive of Streptococcal pharyngitis a) fever b) tonsillar enlargement & exudate c) absence of cough or coryza d) cervical lymphadenopathy 3) strawberry tongue Laboratory: 1) also see pharyngitis 2) labs specific for Streptococcal pharyngitis a) Centor scoring system used for determining whether laboratory testing needed prior to therapy - patients who meet all 4 Centor criteria should be treated without laboratory testing - laboratory testing indicated if 2 or 3 Centor criteria met [7] b) rapid screen for group A streptococcus [9] c) negative rapid antigen test followed up by culture for beta-hemolytic streptococcus (gold standard) [7] 3) not necessary to test patients with viral symptoms (e.g., cough, oral ulcers, rhinorrhea) [5] 4) testing is not necessary in children < 3 years of age unless they have an older sibling with group A Streptococcal infectionor other risk factors Complications: 1) post-streptococcal glomerulonephritis 2) rheumatic fever Management: 1) Centor scoring system used for determining therapy [3] 2) penicillin for group A streptococcus a) prevents non-suppurative sequelae if started within 48 hours b) 10 days of therapy recommended c) penicillin V 500 mg PO BID (as effective as TID or QID) d) penicillin V 800 mg QID for 5 days as effective 500 mg TID for 10 days [9] e) penicillin or amoxicillin as effective & associated with fewer adverse events than amoxicillin clavulanate or cephalosporins in children [8] 3) erythromycin or other macrolide, clindamycin, or first-generation cephalosporin in penicillin-allergic patients a) 10 days of therapy b) 5 days of therapy for azithromycin [5] 4) prednisone 60 mg PO once (adults) a) may diminish pain b) adjunctive use of glucocorticoids controversial [1]

Related

group A beta-hemolytic streptococcus

General

pharyngitis Streptococcal infection; streptococcosis

References

  1. Niland ML, Bonsu BK, Nuss KE, Goodman DG. A pilot study of 1 versus 3 days of dexamethasone as add-on therapy in children with streptococcal pharyngitis. Pediatr Infect Dis J. 2006 Jun;25(6):477-81. PMID: 16732143
  2. Gerber MA et al Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. A Scientific Statement From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research Circulation 2009;119:... PMID: 19246689 http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.191959v1
  3. McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004 Apr 7;291(13):1587-95. PMID: 15069046 - Centor RM et al Pharyngitis management: defining the controversy. J Gen Intern Med. 2007 Jan;22(1):127-30. PMID: 17351852 - Centor RM Expand the pharyngitis paradigm to adolescents and young adults Annals of Internal Medicine 2009, 151:812 PMID: 19949147 http://www.annals.org/content/151/11/812.abstract
  4. Fine AM et al. Improved diagnostic accuracy of group A streptococcal pharyngitis with use of real-time biosurveillance. Ann Intern Med 2011 Sep 20; 155:345 PMID: 21930851
  5. Shulman ST et al Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America Clin Infect Dis. (2012) Sept 9 PMID: 22965026 http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full (corresponding NGC guideline withdrawn Jan 2018) - Centor RM. When should patients seek care for sore throat? Ann Intern Med 2013 Nov 4; 159:636 PMID: 24189598 - Kaplan EL. Streptococcal pharyngitis in adults: Can it be efficiently and effectively managed by remote control? Ann Intern Med 2013 Nov 4; 159:638. PMID: 24189599
  6. The NNT: Streptococal Pharyngitis Diagnostics and Likelihood Ratios, Explained http://www.thennt.com/lr/streptococal-pharyngitis/ - Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA. 2000 Dec 13;284(22):2912-8. PMID: 11147989 - Shaikh N, Swaminathan N, Hooper EG. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. J Pediatr. 2012 Mar;160(3):487-493.e3 PMID: 22048053
  7. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  8. Gerber JS, Ross RK, Bryan M et al Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections. JAMA. 2017;318(23):2325-2336 PMID: 29260224 https://jamanetwork.com/journals/jama/article-abstract/2666503
  9. Skoog Stahlgren G et al. Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: Randomised controlled, open label, non-inferiority study. BMJ 2019 Oct 4; 367:l5337. PMID: 31585944 Free PMC Article https://www.bmj.com/content/367/bmj.l5337
  10. Hedin K, Thorning S, van Driel ML. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2023 Nov 15;11(11):CD004406. PMID: 37965935 PMCID: PMC10646936 (available on 2024-11-15)