what is pharyngitis
inflammation in the back of throat aka sore throat
what causes pharyngitis
- allergies
- medications (ie steroid nasal spray)
- irritating substances (hot/cold/smoke)
- trauma
- tumors
- infection
- *POINT BEING NOT EVERY SORE THROAT MEANS INFECTION
what is the most common cause of pharyngitis
rhinovirus- also can be many things like coronavirus or influenza, etc
is viral or bacterial more common
viral- wayyyyyy- up to 80% of the time
-means it is self limiting, can treat sx if bothersome but antimicrobials will not work
what virus causes mono
epstein barr virus- very sore throat, but not as common
where will antibiotics work for a sore throat?
only in 5-15% of bacterial cases- they are caused by group a hemolytic streptococci (GAS)
-most bacteria will go away on own, all other bacterial infections are self limiting
how common are bacterial cases
at most, 20%, and not all bacterial cases need treatment
why is there an overuse of antibiotics leading to antibiotic resistance?
- patients expect them, aren’t satisfied without rx
- will see other MD if don’t get them
- quicker for MD to write rx than explain why don’t need one
- BUT, not valid reasons, studies show they don’t care as long as you explain to them- might be better to rx a throat spray, analgesic etc instead
how it spreads
most among close contacts, with kids being the major reservoir
how common is group a strep in kids?
very unusual in children under 3, don’t consider ABs for them ususally
what is antimicrobial stewardship about?
not only using the right AB, but determining if they actually need one
signs and sx of GAS
-painful swallowing, exudates, enlarged anterior cervical nodes (neck), fever sometimes, increased WBCs (but blood work is rarely done so hard to tell), N/V (esp in children, but no diarrhea. Gut reacts to a lot of things in children very non specifically), scarlatiform (fine, pinpoint sand papery red rash/lesions) rash sometimes
what system helps determine the likelyhood of strep
center score
what are the anterior cervical lymph nodes?
- prelaryngeal
- thyroid
- pretracheal
- parathacheal
how to diagnose GAS
- culture=gold standard (over 90% sensitivity), may take 1-2 days
- rapid antigen detection test- takes minutes but very expensive, only 70-90% sensitivity
- *CANNOT DIAGNOSE FROM SX ALONE
if pharyngitis is untreated, how long does it usually last
- self limiting, lasts 8-10 days
- decrease in pain and SEs by about 16 hours at best with ABs
why do we treat strep
- to get rid of sore throat
- reduce transmission to others
- sometimes to reduce complications
- prevent rheumatic heart disease
what are complications of strep, and how to ABs play a role
- immune complex with the antigen deposited in kidneys “acute post streptococcal glomerular nephritis”- no impact from ABs on development of this. 95% of cases will improve without treating kidney
- tonsilitis (most common)- ABs can reduce sx, but this is still not that common in the grand scheme
- peritonsillar absess
- lymph adenitis
- otitis media
- sinusitis
why could strep cause RHD (rheumatic heart disease), and how ABs play a role
- antibodies against strep can cross react with heart proteins causing damage (usually to valves). Antibiotics can prevent RHD, however, it is so rare and you would have to treat a huge population to help one, all while spreading AB resistance- certainly worth it in children, in adults not as much
- to prevent RHD, must treat with ABs within 9 days of sx onset- definitely have time to wait for a culture to come back
starting AB therapy in _____ days of sx can improve by about ______ days
2-3
1-2 (more like 16 hours)
*important to recommend sx relief if bothering them
when can a child go back to school after strep?
within 24 hours of AB therapy if feeling better as well
-in everyone, you reduce the risk of transmission to other in just 24 hours with AB treatment
drug of choice for GAS and why
- Penicillin V
- narrow spectrum of activity, safe/effective/cheap
- no known resistance to it from GAS; it is extremely sensitive to it
dose of Penicilin V for GAS, therapy length, how to take, AE
- 300mg TID (or QID, but harder to comply with, or 600mg BID, TID therapy is better because of short half life ie don’t do BID, and OD doesn’t work) for 10 days
- preferably taken on an empty stomach
- almost no AE except upset stomach possible
- feel better in a few days
- peds: 40mg/kg/day
second choice for treating GAS, dosage, kids,
Amoxicillin- beta lactams have shown efficacy, but have broader spectrum than pen V
- suspension tastes a lot better- use for kids, but still recommend pen V for adults
- 500mg TID adults for 10 days
- peds 40-50mg/kg/day TID for 10 days
- can be taken with meals
