Acute Pharyngitis

Respiratory Tract: Acute Pharyngitis Respiratory Tract: Acute Pharyngitis Respiratory Tract: Acute Pharyngitis QUICK FACTS1-2:

• Only 5-15%of adult casesof acutepharyngitisarecaused byGroup AQUICK FACTS1-2: β-hemolytic • streptococci (GAS).Only 5-15% of adult cases of acute pharyngitis are caused by Group A β-hemolytic • It isestimated that 3,000to4,000patientswith GASmust betreated forevery1 streptococci (GAS). • case ofacute rheumaticfeverprevented. It is estimated that 3,000 to 4,000 patients with GAS must be treated for every 1 • Antibiotictherapyof GAShastensresolution by1 case of acute rheumatic fever prevented. -2daysif initiated within 2-3 days • of symptom onset. Antibiotic therapy of GAS hastens resolution by 1-2 days if initiated within 2-3 days

CLASSIFICATION of symptom onset C . LINICAL PRESENTATION RECOMMENDED REGIMENS C CLINICAL ONSIDERATIONS

CLASSIFICATION CLINICAL PRESENTATION RECOMMENDED REGIMENS Group A β-hemolytic streptococcus Group A (GAS) β-hemolytic streptococcus (GAS) ≥ 2ofthe following:

• Fever(≥ 100.4°) • Tonsillar exudates • No cough • Tender anterior cervical lymphadenopathy ≥ 2 of the following: • Fever (≥ 100.4°) • Tonsillar exudates • No cough • Tender anterior (lymphadenitis) cervical • Scarlatiniform rash lymphadenopathy (lymphadenitis) • Scarlatiniform rash

CLINICAL

Amoxicillin500 mg PO Clinical suspicion CONSIDERATIONS Q12H forGAS: OR Amoxicillin 500 mg PO Obtain throat swab Clinical suspicion PenicillinVK250 mg Q6H Q12H OR order GAS rapidfor GAS: OR OR antigen detection Obtain throat swab Penicillin500 mg POQ12H Penicillin VK 250 mg Q6H test (RADT)* OR order GAS rapid OR antigen detection For 10days Penicillin 500 mg PO Q12H If culture is test (RADT)* Penicillin Allergy Non-anaphylactic allergy: Cephalexin500 mg PO Q12H x 10 days OR Clindamycin300 mg PO Q6Hfor10 days OR For 10 days Penicillin Allergy Non-anaphylactic allergy: Cephalexin 500 mg PO Q12H x 10 days OR Clindamycin 300 mg PO negative: No antibiotics AND consider supportive treatment (antipyretic OR analgesic) If culture is negative: No antibiotics AND consider supportive treatment (antipyretic OR analgesic) Azithromycin500 mg POx Q6H for 10 days 1 day,then250 mg PO OR Q24Hx4 days Azithromycin 500 mg PO x 1 day, then 250 mg PO Viral Pharyngitis • Conjunctivitis Supportive treatment Q24H x 4 days Viral Pharyngitis • • • • • • • • • • • • Coryza Cough Diarrhea Hoarseness Discrete ulcerative stomatitis Viral exanthema Conjunctivitis Coryza Cough Diarrhea Hoarseness Discrete ulcerative (antipyretic OR analgesic)Supportive treatment (antipyretic OR analgesic) stomatitis GAS=GroupAβ-hemolytic Streptococci;H=hour(s);PO=by mouth;Q= every;RADT=Rapidantigendetectiontest • Viral exanthema *Throatswabculture sensitivity:90-95%; RADT: sensitivity70-90%,specificity 95%

GAS= Group A β-hemolytic Streptococci; H= hour(s); PO= by mouth; Q= every; RADT= Rapid antigen detection test *Throat swab culture sensitivity: 90-95%; RADT: sensitivity 70-90%, specificity 95%

References:

1. Shulman ST, Bisno AL, Clegg HW, et al. Clinical Practice Guidelines for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society America. Clin Infect Dis. 2012 Nov 15;55(10):1279References: 1. 82. Shulman ST, Bisno AL,CleggHW,etal.Clinical Practice Guidelinesforthe DiagnosisandManagementofGroupA 2. Cooper RJ et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Streptococcal Pharyngitis:2012Updateby theInfectiousDiseasesSociety America. Clin Infect Dis. 2012Nov15;55(10):1279-

Medicine. 82. 2001;134(6):509-17. 2. CooperRJetal.Principlesofappropriateantibiotic use foracute pharyngitisinadults:Background. Annals of Internal

Medicine. 2001;134(6):509-17. PAGE 17