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Streptococcal Pharyngitis - #PHARMFAX

Group A beta-hemolytic streptococcus are the most common bacterial cause for pharyngitis.

 


Group A beta-hemolytic streptococcus are the most common bacterial cause for pharyngitis. Several other infections overlap with the clinical presentation of strep throat. Findings most consistent with pharyngitis include exudates, erythema, and pharyngeal wall cobblestoning.


Viral etiologies are common compared to bacterial for pharyngitis. This is important to emphasize because of the overuse of antibiotics for pharyngitis. Viral pharyngitis is self-limiting, making antibiotics ineffective and promote antimicrobial resistance. More common symptoms of viral etiologies are rhinorrhea, cough, oral ulcers, and horaseness.


Physical examinations, scoring systems such as the Centor criteria, and diagnostics assist with determining bacterial vs viral causes. Antibiotics are recommended for patients who test positive on Group A Streptoccocal diagnostics.


Pencillin G Benzathine 600,000 units intramuscular for those less than 27 kg and 1.2 million for patients greater than 27 kg. Penicillin 250 - 500 mg tablets two to four times daily depending on age and weight is an oral option. Amoxicillin 50 mg/kg/day with a max of 1000 mg daily x 10 days. Patients with true pencillin allergies, clindamycin, cephalexin, and azithromycin are considered alternatives. Reference your local antibiogram for the best empiric agent.


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References

  1. Choby, B. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009 Mar 1;79(5):383-90.

  2. Luo et al. Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011-2015. BMC Infect Dis. 2019 Feb 26;19(1):193. doi: 10.1186/s12879-019-3835-4.

  3. Mustafa Z, Ghaffari M. Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review. Front Cell Infect Microbiol. 2020; 10: 563627.

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