Streptococcal pharyngitis

Acute pharyngitis presents a diagnostic and therapeutic dilemma. The majority of sore throats are caused by a variety of viruses fewer than 20% are bacterial and hence potentially responsive to antibiotic therapy. However, antibiotics are widely prescribed and this reflects the difficulty in discriminating streptococcal from non-streptococcal infections clinically in the absence of microbiological documentation. Nonetheless, Strep, pyogenes is the most important bacterial pathogen and this responds to oral penicillin. However, up to 10 days treatment is required for its eradication fixm the throat. This requirement causes problems with compliance since symptomatic improvement generally occurs within 2-3 days. 

Identify clinical signs and symptoms associated with acute otitis media, bacterial rhinosinusitis, and streptococcal pharyngitis. 

Recommend appropriate adjunctive therapy for a patient with acute otitis media, acute bacterial rhinosinusitis, or streptococcal pharyngitis. 

The goals of therapy for streptococcal pharyngitis are to eradicate infection, reduce symptoms and infectivity, and prevent complications. 

Penicillin is the drug of choice for streptococcal pharyngitis, but cephalosporins may be appropriate alternative first-line agents owing to increasing failure rates after penicillin therapy. 

Does this child have streptococcal pharyngitis ... 

These tests should be performed only if there is a clinical suspicion of streptococcal pharyngitis. 

The goals of therapy for streptococcal pharyngitis are to eradicate infection in order to prevent complications, shorten the disease course, and reduce infectivity and spread to close contacts. Sequelae that can be prevented by antibiotic use are peritonsillar or retropharyngeal abscess, cervical lymphadenitis, and rheumatic fever. There is no evidence that antibiotic use has an impact on the incidence of poststreptococcal glomerulonephritis. 

Assess the patient s signs and symptoms. Are they consistent with streptococcal pharyngitis Are symptoms of viral infection present ... 

Bisno AL, Gerber MA, Gwaltney JM Jr, et al. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis 2002 35(2) 113-125. 

The incubation period is 2 to 5 days, and the illness often occurs in clusters. The clinical presentation of Group A streptococcal pharyngitis is presented in Table 44-4. 

Clinical Presentation and Diagnosis of Group A Streptococcal Pharyngitis... 

Antimicrobial therapy should be limited to those who have clinical and epidemiologic features of Group A streptococcal pharyngitis with a positive laboratory test. 

The duration of therapy for Group A streptococcal pharyngitis is 10 days to maximize bacterial eradication. 

Sulfouamides have a broad spectrum of antimicrobial activity, including Staphylococcus aureus, nonenterococcal types of Streptococcus, Listeria monocytogenes, Nocardia, Neisseria, Haemophilius influenzae, enteric Gram-negative types of E. coli, Proteus mirabilis, and a few forms of anaerobic bacteria. Above all, sulfonamides are used for treating uncomplicated infections of the urinary tract, infections caused by Nocardia asteroids, streptococcal pharyngitis, menigococcal diseases, toxoplasmosis, and others. 

Pharyngitis, tonsiiiitis 30 mg/kg/day in single or 2 divided doses. For -hemolytic streptococcal infections, continue treatment for at least 10 days. 

Streptococcal pharyngitis, skin and skin structure infections, uncomplicated cystitis In patients older than 15 years of age 500 mg every 12 hours. 

Monohydrate 25 to 50 mg/kg/day in divided doses. For streptococcal pharyngitis in patients older than 1 year of age and for skin and skin structure infections, divide total daily dose and give every 12 hours. In severe infections, double the dose. 

Oral beta-lactam antibiotics such as amoxycillin, cotrimoxazole or doxycycline for 7-10 days are suitable for the treatment of bacterial sinusitis. Furuncles of the nose should be treated with an anti-staphyloccal drug for 5 days. Standard treatment for streptococcal pharyngitis consists of 10 days of penicillin. Malignant otitis externa responds to high dose quinolone therapy (e.g. ciprofloxacin 750 mg 2 t.d.) administered orally. For parapharyngeal abscess, high dose penicillin plus beta-lactamase inhibitors such as amoxycillin-clavulanic acid can be used. Duration of treatment is guided by clinical and parameters of inflammation, and abscesses often need several weeks to resolve by conservative treatment. 

Skin and skin-structure infections, group A beta-hemolytic streptococcal pharyngitis, tonsillitis PO 1 2g in 2 divided doses. 

A child with Tourette s disorder is treated with a daily dose of 2 mg of pimozide for tics. A family doctor treats a streptococcal pharyngitis with clarithromycin, and 24 hours later the child develops palpitations. An electrocardiogram (ECG) reveals a QTc prolongation to 0.465 milliseconds. 

Allen et al., 1995). To increase confidence that an affected child belongs in the PANDAS subgroup, there must be at least two symptom exacerbations occurring subsequently to documented GABHS infections, and one or more periods of partial or complete quiescence of symptoms in the absence of streptococcal pharyngitis. 

Kaplan, E.L. (1971) Diagnosis of streptococcal pharyngitis differentiation of active infection from carrier state in the symptomatic child. J Infect Dis 123 490-501. 

Streptococcal infections Pharyngitis, rheumatic fever, otitis media and even for subacute bacterial endocarditis. Staphylococcal infections Penicillinase resistant penicillin can be used. Meningococcal infections Meningitis other infections caused by meningococci. 

Benzathine penicillin and procaine penicillin G for intramuscular injection yield low but prolonged drug levels. A single intramuscular injection of benzathine penicillin, 1.2 million units, is effective treatment for 3-hemolytic streptococcal pharyngitis given intramuscularly once every 3-4 weeks, it prevents reinfection. Benzathine penicillin G, 2.4 million units intramuscularly once a week for 1-3 weeks, is effective in the treatment of syphilis. Procaine penicillin G, formerly a work horse for treating uncomplicated pneumococcal pneumonia or gonorrhea, is rarely used now because many strains are penicillin-resistant. 

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