Source: Frei C, Frei B, Zhanel
G. Upper Respiratory Tract Infections. In: DiPiro, JT, Talbert RL,
Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8001906.
Accessed July 15, 2012.
- Infection of oropharynx or nasopharynx
- Viral causes most common:
- Primary bacterial cause: group A β-hemolytic Streptococcus (GABHS) or Streptococcus pyogenes
15–30% of cases in pediatric patients and 5–15% in
- Mechanism by which GABHS causes pharyngitis not well defined.
- 5–20% of children GABHS carriers.
- Highest susceptibility: children ages 5–5 years
- Highest incidence in winter and early
- Incubation period: 2–5 days
- Infectious during acute illness and next 7 days.
antibiotic therapy reduces infection period to ~24 hours.
- Spread occurs via droplet transmission.
- Children who attend school
- Parent of school-age child
- Working with school-age children
- Most common symptom of pharyngitis: sudden onset of sore
throat, mostly self-limited.
- Similar for viral and nonstreptococcal bacterial causes
- Sore throat
- Pain on swallowing
- Abdominal pain (especially in children)
- Erythema/inflammation of tonsils and pharynx with
or without patchy exudates
- Enlarged, tender lymph nodes
- Swollen red uvula
- Petechiae on soft palate
- Scarlatiniform rash
- Signs suggestive of viral origin:
Means of Confirmation
- Guidelines from Infectious Disease Society of America,
American Academy of Pediatrics, and American Heart Association suggest
that testing for group A Streptococcus be
done in all patients with signs and symptoms.
- Centor criteria used to predict GABHS pharyngitis.
- Recommendation: limit testing to patients who meet ≥2 Centor
criteria to minimize overtesting.
- Throat swab and culture
- Rapid antigen detection testing
- Viral pharyngitis
- Epstein-Barr virus (EBV)/infectious mononucleosis
- Improve clinical signs and symptoms.
- Minimize adverse drug reactions.
- Prevent transmission to close contacts.
- Prevent acute rheumatic fever.
- Prevent suppurative complications such as:
- Peritonsillar abscess
- Cervical lymphadenitis
- Antimicrobial treatment should be limited to patients
with clinical and epidemiologic features of GABHS pharyngitis with
positive laboratory test.
- Self-care for pain relief
better option because there is some concern that NSAIDs may increase
risk for necrotizing fasciitis or toxic shock syndrome.
- Nonprescription lozenges and sprays containing menthol and
- Salt-water gargling
- Penicillin drug of choice in treatment of GABHS pharyngitis
- Treat for 10 days to maximize bacterial
- If allergic to penicillin, macrolide such as erythromycin
or first-generation cephalosporin such as cephalexin (if reaction
is non-immunoglobulin E–mediated hypersensitivity) can
- Dosing guidelines for recurrent infections varies
- Table 2 presents evidence-based principles for diagnosis of
group A Streptococcus pharyngitis.
Table 1. Dosing Guidelines