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| __NOTOC__ | | __NOTOC__ |
| {{Pharyngitis}} | | {{Pharyngitis}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{chetan}}, {{VSKP}} |
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| | ==Overview== |
| | The majority of cases of [[pharyngitis]] are [[self-limited]] and only require [[symptomatic therapy]]. Accurate diagnosis of [[streptococcal]] [[pharyngitis]] followed by appropriate [[antimicrobial]] therapy is important for the prevention of [[acute rheumatic fever]], for the prevention of [[suppurative]] complications (e.g, [[peritonsillar abscess]], [[cervical]] [[lymphadenitis]], [[mastoiditis]], and, possibly, other invasive infections), to improve clinical symptoms and signs, for the rapid decrease in [[contagiousness]], for the reduction in transmission of [[Group A streptococcal|GAS]] to family members, classmates, and other close contacts of the patient to allow for the rapid resumption of usual activities; and for the minimization of potential adverse effects of inappropriate [[antimicrobial]] therapy. |
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| ==Medical Therapy== | | ==Medical Therapy== |
| Acute pharyngitis should be treated according to the etiologic agent. The most common causes of pharyngitis are: | | *[[Acute pharyngitis]] should be treated according to the etiologic agent.<ref name="pmid23091044">Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al. (2012) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23091044 Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America.] ''Clin Infect Dis'' 55 (10):1279-82. [http://dx.doi.org/10.1093/cid/cis847 DOI:10.1093/cid/cis847] PMID: [https://pubmed.gov/23091044 23091044]</ref> |
| =====Viral infections=====
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| Most common cause of infection in children. The most common viral infection are [[Adenovirus]], [[rhinovirus]], influenza A and B, [[parainfluenza]] 1,2,3. Most of them a self limiting however a few may need antiviral in the immunocompromised.<ref name="Bisno-1996">{{Cite journal | last1 = Bisno | first1 = AL. | title = Acute pharyngitis: etiology and diagnosis. | journal = Pediatrics | volume = 97 | issue = 6 Pt 2 | pages = 949-54 | month = Jun | year = 1996 | doi = | PMID = 8637780 }}</ref>
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| <ref name="Bisno-1996">{{Cite journal | last1 = Bisno | first1 = AL. | title = Acute pharyngitis: etiology and diagnosis. | journal = Pediatrics | volume = 97 | issue = 6 Pt 2 | pages = 949-54 | month = Jun | year = 1996 | doi = | PMID = 8637780 }}</ref>
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| =====Bacterial infections=====
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| They usually require antibiotics as group A beta-hemolytic streptococcus (GAS) is the most common . If bacteria are recovered from throat culture they do not need antibiotics are they dont cause pharyngitis .
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| =====Allergic infection=====
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| Treat allergic infection with systemic or topical anti-histaminics.
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| There are three types of treatment: '''symptomatic''', '''remedial''' and '''preventive'''. Symptomatic treatments are aimed at reducing pain and symptoms. Remedial treatments attempt to cure pharyngitis by reducing its spread and speeding up the healing process. Preventive treatments attempt to block the start of an infection.
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| Remedial treatments are mostly effective for bacterial infections such as streptococcal infections. For viral infections, even with treatment, most cases of pharyngitis will still settle spontaneously within a few days. Hence the most popular method of treatment is symptomatic. Many preventive treatments are also remedial, thus those two treatments will be listed in the same section.
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| Twenty-two non-antibiotic managements for sore throat have been studied in controlled trials.<!--
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| --><ref name="Thomas">{{cite journal | author= Thomas M, Del Mar CB, Glasziou P. | title=How effective are treatments other than antibiotics for acute sore throat? | journal=Br J GP| year=2000 | volume=50 | issue=459 | pages=817-820| id = PMID 11127175 | url=http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1313826&blobtype=pdf | format=PDF}}</ref><!-- -->Analgesics are among the most effective, but there are many simple measures that can also be used.
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| ===Symptomatic treatments=== | |
| * Analgesics such as [[NSAIDs]] can help reduce the pain associated with a sore throat.<ref name="Thomas"/>
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| * [[Throat lozenge]]s ([[cough medicine]]) are often used for short-term pain relief.
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| * Avoid foods and liquids highly acidic in nature, as they will provoke temporary periods of intense pain.
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| * Warm tea ([[tea|true]] or Tisane) or soup can help temporarily alleviate the pain of a sore throat.
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| * Cold beverages, popsicles and ice cubes numb the nerves of the throat somewhat, alleviating the pain for a brief time.
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| * Mouthwash (when gargled) reduces the pain but only for a brief time.
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| * Drinking heavy amounts of liquid reduces the pain for a short time.
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| * Peppermint candy might help with some cases as well as other hard candies. It will reduce the pain for a short time.
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| * Yogurt has been shown to help alleviate the pain temporarily by coating the affected area. Milk also has the same effect.
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| * [[Gargling]] with warm saline solution may help reduce mucus. <ref>{{cite web |url=http://www.mayoclinic.com/health/sore-throat/DS00526/DSECTION=10|title=Sore throat: Self-care - MayoClinic.com |accessdate=2007-09-17 |format= |work=}}</ref> While it is a popular household remedy, there is little evidence that it provides any long-term benefit.
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| ===Remedial and preventive treatments===
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| Performing remedial treatments early when a patient's throat begins to feel scratchy may help the infection from spreading to the rest of the throat and back of the mouth, which can result in difficulty in swallowing. Treatment should begin the first or second day of the illness, however if the patient has a cold or the flu, the infection may still continue to spread to other areas such as the ears through the [[eustachian tube]] (causing an earache) and to the lungs through the [[trachea]] (causing a cough). Healthy people who will be in frequent contact with someone with pharyngitis may also try the measures below, of which some can be also be preventive, to help inhibit the start of an infection.
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| * The use of [[antibiotic]]s is a helpful remedial treatment when a bacterial infection is the cause of the sore throat. For viral sore throats, antibiotics have no effect.
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| * Honey has long been used for treating sore throats due to its [[antiseptic]] properties.<ref>{{cite journal |author=Ramoutsaki I, Papadakis C, Ramoutsakis I, Helidonis E |title=Therapeutic methods used for otolaryngological problems during the Byzantine period |journal=Ann. Otol. Rhinol. Laryngol. |volume=111|issue=6 |pages=553-7 |year=2002 |pmid=12090712}}</ref>
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| * Swallowing a couple teaspoons of raw lemon or lime juice several times a day may help destroy microorganisms in bacteria-related throat infections.<ref name="urlUSE OF CITRIC ACID AS ANTIMICROBIAL AGENT OR ENHANCER OR AS ANTICANCER AGENT - SHANBROM TECH LLC">{{cite web |url=http://www.freepatentsonline.com/EP1331947.html |title=USE OF CITRIC ACID AS ANTIMICROBIAL AGENT OR ENHANCER OR AS ANTICANCER AGENT - SHANBROM TECH LLC |format= |work= |accessdate=}}</ref> Research also shows that lemon juice may destroy some viruses such as HIV.<ref name="urlLemon juice may kill AIDS virus: research - ABC News (Australian Broadcasting Corporation)">{{cite web |url=http://www.abc.net.au/news/stories/2004/07/12/1152319.htm |title=Lemon juice may kill AIDS virus: research - ABC News (Australian Broadcasting Corporation) |format= |work= |accessdate=}}</ref> This remedy should be started during the first or second day of sickness because citric acid can irritate a patient's throat tissues after pharyngitis becomes too widespread. If this is the case, the patient may try a diluted solution of lemon, honey and tea (or lemon with hot water).
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| ===Medical treatment for Acute Pharyngitis===
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| ====Topical therapy====
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| Oral rinses were more effective in treating conditions affecting oral cavity and base of the tongue whereas sprays were more effective in coating the posterior pharynx and hence they were used to treat posterior pharynx conditions.<ref name="Patel-1999">{{Cite journal | last1 = Patel | first1 = SK. | last2 = Ghufoor | first2 = K. | last3 = Jayaraj | first3 = SM. | last4 = McPartlin | first4 = DW. | last5 = Philpott | first5 = J. | title = Pictorial assessment of the delivery of oropharyngeal rinse versus oropharyngeal spray. | journal = J Laryngol Otol | volume = 113 | issue = 12 | pages = 1092-4 | month = Dec | year = 1999 | doi = | PMID = 10767923 }}</ref>
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| =====Oral rinses=====
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| *Salt water gargles which have been used since a long time have not shown any benefit in releiving throat pain . It is still used as it has minimal side effects.
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| *[[Lidocaine]], [[diphenhydramine]] and [[Maalox]] ([[Aluminium hydroxide]], [[magnesium hydroxide]] and simethicone) have shown to be helpful. This combination can be used to treat Coxsackie A or B infection or herpes simplex. Avoid using the lidocaine over its recommended use.<ref name="Hess-1988">{{Cite journal | last1 = Hess | first1 = GP. | last2 = Walson | first2 = PD. | title = Seizures secondary to oral viscous lidocaine. | journal = Ann Emerg Med | volume = 17 | issue = 7 | pages = 725-7 | month = Jul | year = 1988 | doi = | PMID = 3382075 }}</ref><ref name="Gonzalez del Rey-1994">{{Cite journal | last1 = Gonzalez del Rey | first1 = J. | last2 = Wason | first2 = S. | last3 = Druckenbrod | first3 = RW. | title = Lidocaine overdose: another preventable case? | journal = Pediatr Emerg Care | volume = 10 | issue = 6 | pages = 344-6 | month = Dec | year = 1994 | doi = | PMID = 7899121 }}</ref>
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| *[[Benzydamine]] hydrochloride rinses have shown to be help reduce the pain in a few cases. However, they are used more frequently to treat radiation mucositis.<ref name="Turnbull-1995">{{Cite journal | last1 = Turnbull | first1 = RS. | title = Benzydamine Hydrochloride (Tantum) in the management of oral inflammatory conditions. | journal = J Can Dent Assoc | volume = 61 | issue = 2 | pages = 127-34 | month = Feb | year = 1995 | doi = | PMID = 7600413 }}</ref><ref name="Passàli-2001">{{Cite journal | last1 = Passàli | first1 = D. | last2 = Volonté | first2 = M. | last3 = Passàli | first3 = GC. | last4 = Damiani | first4 = V. | last5 = Bellussi | first5 = L. | title = Efficacy and safety of ketoprofen lysine salt mouthwash versus benzydamine hydrochloride mouthwash in acute pharyngeal inflammation: a randomized, single-blind study. | journal = Clin Ther | volume = 23 | issue = 9 | pages = 1508-18 | month = Sep | year = 2001 | doi = | PMID = 11589263 }}</ref><ref name="Wethington-1985">{{Cite journal | last1 = Wethington | first1 = JF. | title = Double-blind study of benzydamine hydrochloride, a new treatment for sore throat. | journal = Clin Ther | volume = 7 | issue = 5 | pages = 641-6 | month = | year = 1985 | doi = | PMID = 3902241 }}</ref><ref name="Epstein-2001">{{Cite journal | last1 = Epstein | first1 = JB. | last2 = Silverman | first2 = S. | last3 = Paggiarino | first3 = DA. | last4 = Crockett | first4 = S. | last5 = Schubert | first5 = MM. | last6 = Senzer | first6 = NN. | last7 = Lockhart | first7 = PB. | last8 = Gallagher | first8 = MJ. | last9 = Peterson | first9 = DE. | title = Benzydamine HCl for prophylaxis of radiation-induced oral mucositis: results from a multicenter, randomized, double-blind, placebo-controlled clinical trial. | journal = Cancer | volume = 92 | issue = 4 | pages = 875-85 | month = Aug | year = 2001 | doi = | PMID = 11550161 }}</ref><ref name="Kim-1986">{{Cite journal | last1 = Kim | first1 = JH. | last2 = Chu | first2 = FC. | last3 = Lakshmi | first3 = V. | last4 = Houde | first4 = R. | title = Benzydamine HCl, a new agent for the treatment of radiation mucositis of the oropharynx. | journal = Am J Clin Oncol | volume = 9 | issue = 2 | pages = 132-4 | month = Apr | year = 1986 | doi = | PMID = 3521255 }}</ref>
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| =====Sprays=====
| | *As [[viral]] infections are the most common causes of [[pharyngitis]] in children, most patients do not require treatment and only need [[supportive care]].<ref name="pmid8637780">Bisno AL (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8637780 Acute pharyngitis: etiology and diagnosis.] ''Pediatrics'' 97 (6 Pt 2):949-54. PMID: [https://pubmed.gov/8637780 8637780]</ref> |
| *Topical anesthetic sprays have been used in the past to treat pharyngitis , however their effect is not signigficant . They may also cause a few allergic reactions and side effects like methemoglobinemia and hence should not be used in children. | | * [[Bacterial]] [[pharyngitis]] is common among young children and adolescents. [[Group A streptococcal pharyngitis]] is the only common form of the disease for which [[antimicrobial]] therapy is definitely indicated. Therefore, when a clinician evaluates a patient with an acute sore throat, the most important clinical task is to decide whether or not the patient has “strep throat.”<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> |
| *Chlorhexidine /benzydamine sprays are more effective in alleviating symptoms of acure viral pharyngitis and group A streptococcal pharyngitis.<ref name="Cingi-2011">{{Cite journal | last1 = Cingi | first1 = C. | last2 = Songu | first2 = M. | last3 = Ural | first3 = A. | last4 = Erdogmus | first4 = N. | last5 = Yildirim | first5 = M. | last6 = Cakli | first6 = H. | last7 = Bal | first7 = C. | title = Effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray on clinical signs and quality of life of patients with streptococcal tonsillopharyngitis: multicentre, prospective, randomised, double-blinded, placebo-controlled study. | journal = J Laryngol Otol | volume = 125 | issue = 6 | pages = 620-5 | month = Jun | year = 2011 | doi = 10.1017/S0022215111000065 | PMID = 21310101 }}</ref><ref name="Cingi-2010">{{Cite journal | last1 = Cingi | first1 = C. | last2 = Songu | first2 = M. | last3 = Ural | first3 = A. | last4 = Yildirim | first4 = M. | last5 = Erdogmus | first5 = N. | last6 = Bal | first6 = C. | title = Effects of chlorhexidine/benzydamine mouth spray on pain and quality of life in acute viral pharyngitis: a prospective, randomized, double-blind, placebo-controlled, multicenter study. | journal = Ear Nose Throat J | volume = 89 | issue = 11 | pages = 546-9 | month = Nov | year = 2010 | doi = | PMID = 21086279 }}</ref>
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| =====Lozenges===== | | ===Corticosteroids=== |
| *Medical throat lozenges help reducing the duration of symptoms and also provide with some sympotomatic relief. They do come with a few side effects similiar to sprays like methemoglobinemia. They are not recommended for children as there is a risk of choking Lozenges containing antisepotics, menthol , anesthetics and antiflammatory agents have been used.<ref name="Bisno-2001">{{Cite journal | last1 = Bisno | first1 = AL. | title = Acute pharyngitis. | journal = N Engl J Med | volume = 344 | issue = 3 | pages = 205-11 | month = Jan | year = 2001 | doi = 10.1056/NEJM200101183440308 | PMID = 11172144 }}</ref><ref name="Watson-2000">{{Cite journal | last1 = Watson | first1 = N. | last2 = Nimmo | first2 = WS. | last3 = Christian | first3 = J. | last4 = Charlesworth | first4 = A. | last5 = Speight | first5 = J. | last6 = Miller | first6 = K. | title = Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomised, double-blind, placebo-controlled study of efficacy and safety. | journal = Int J Clin Pract | volume = 54 | issue = 8 | pages = 490-6 | month = Oct | year = 2000 | doi = | PMID = 11198725 }}</ref><ref name="-2007">{{Cite journal | title = Flurbiprofen: new indication. Lozenges: NSAIDs are not to be taken like sweets! | journal = Prescrire Int | volume = 16 | issue = 87 | pages = 13 | month = Feb | year = 2007 | doi = | PMID = 17323518 }}</ref>
| | [[Corticosteroids]] have been studied and recommended by a guideline<ref name="pmid28931507">{{cite journal| author=Aertgeerts B, Agoritsas T, Siemieniuk RAC, Burgers J, Bekkering GE, Merglen A et al.| title=Corticosteroids for sore throat: a clinical practice guideline. | journal=BMJ | year= 2017 | volume= 358 | issue= | pages= j4090 | pmid=28931507 | doi=10.1136/bmj.j4090 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28931507 }} [http://annals.org/aim/fullarticle/2669671/guideline-experts-recommend-single-dose-oral-steroids-pain-relief-acute ACPJC review]</ref>, but results were heterogeneous in a [[meta-analysis]]<ref name="pmid28931508">{{cite journal| author=Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R, Papola D, Lytvyn L, Vandvik PO et al.| title=Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. | journal=BMJ | year= 2017 | volume= 358 | issue= | pages= j3887 | pmid=28931508 | doi=10.1136/bmj.j3887 | pmc=5605780 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28931508 }} </ref>. |
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| ====Systemic Therapy====
| | The most recent trial in the meta-analysis showed<ref name="pmid28418482">{{cite journal| author=Hayward GN, Hay AD, Moore MV, Jawad S, Williams N, Voysey M | display-authors=etal| title=Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults: A Randomized Clinical Trial. | journal=JAMA | year= 2017 | volume= 317 | issue= 15 | pages= 1535-1543 | pmid=28418482 | doi=10.1001/jama.2017.3417 | pmc=5470351 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28418482 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=28806797 Review in: Ann Intern Med. 2017 Aug 15;167(4):JC16] </ref>: |
| =====Analgesics=====
| | * Insignificant benefit in the primary outcome at 24 hours. [[Risk difference]] of 4.7% (95% CI, −1.8% to 11.2%) |
| Analgesics are prescribed for moderate to severe pain. Acetaminophen , Nonsteroidal antiinflammatory drugs (NSAID) have shown to decrease pain symptoms. They may also help in reducing fever and inflammation.<ref name="Thomas-2000">{{Cite journal | last1 = Thomas | first1 = M. | last2 = Del Mar | first2 = C. | last3 = Glasziou | first3 = P. | title = How effective are treatments other than antibiotics for acute sore throat? | journal = Br J Gen Pract | volume = 50 | issue = 459 | pages = 817-20 | month = Oct | year = 2000 | doi = | PMID = 11127175 }}</ref><ref name="Gehanno-2003">{{Cite journal | last1 = Gehanno | first1 = P. | last2 = Dreiser | first2 = RL. | last3 = Ionescu | first3 = E. | last4 = Gold | first4 = M. | last5 = Liu | first5 = JM. | title = Lowest effective single dose of diclofenac for antipyretic and analgesic effects in acute febrile sore throat. | journal = Clin Drug Investig | volume = 23 | issue = 4 | pages = 263-71 | month = | year = 2003 | doi = | PMID = 17535039 }}</ref><ref name="Schachtel-1993">{{Cite journal | last1 = Schachtel | first1 = BP. | last2 = Thoden | first2 = WR. | title = A placebo-controlled model for assaying systemic analgesics in children. | journal = Clin Pharmacol Ther | volume = 53 | issue = 5 | pages = 593-601 | month = May | year = 1993 | doi = | PMID = 8491069 }}</ref><ref name="Bertin-1991">{{Cite journal | last1 = Bertin | first1 = L. | last2 = Pons | first2 = G. | last3 = d'Athis | first3 = P. | last4 = Lasfargues | first4 = G. | last5 = Maudelonde | first5 = C. | last6 = Duhamel | first6 = JF. | last7 = Olive | first7 = G. | title = Randomized, double-blind, multicenter, controlled trial of ibuprofen versus acetaminophen (paracetamol) and placebo for treatment of symptoms of tonsillitis and pharyngitis in children. | journal = J Pediatr | volume = 119 | issue = 5 | pages = 811-4 | month = Nov | year = 1991 | doi = | PMID = 1941391 }}</ref><ref name="Benarrosh-">{{Cite journal | last1 = Benarrosh | first1 = C. | title = [Multicenter double blind study of tiaprofenic acid versus placebo in tonsillitis and pharyngitis in children]. | journal = Arch Fr Pediatr | volume = 46 | issue = 7 | pages = 541-6 | month = | year = | doi = | PMID = 2688592 }}</ref><ref name="Eccles-2003">{{Cite journal | last1 = Eccles | first1 = R. | last2 = Loose | first2 = I. | last3 = Jawad | first3 = M. | last4 = Nyman | first4 = L. | title = Effects of acetylsalicylic acid on sore throat pain and other pain symptoms associated with acute upper respiratory tract infection. | journal = Pain Med | volume = 4 | issue = 2 | pages = 118-24 | month = Jun | year = 2003 | doi = | PMID = 12873261 }}</ref>Aspirin should be avoided in children as it may cause [[Reye's syndrome]] .Only for severe pain codeine may be added to the NSAID.
| | * Significant benefit at the secondary outcome of 48 hours. [[Risk difference]] of 8.7% (95% CI, 1.2% to 16.2%) |
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| =====Glucocorticoids===== | | ===Other Treatment Regimen=== |
| They may alleviate pain , and may also be beneficial in patients of Group A streptococcal pharyngitis. No benefits were obtained by adding single dose glucocorticoid to antimicrobial therapy in children.<ref name="Olympia-2005">{{Cite journal | last1 = Olympia | first1 = RP. | last2 = Khine | first2 = H. | last3 = Avner | first3 = JR. | title = Effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children. | journal = Arch Pediatr Adolesc Med | volume = 159 | issue = 3 | pages = 278-82 | month = Mar | year = 2005 | doi = 10.1001/archpedi.159.3.278 | PMID = 15753273 }}</ref><ref name="O'Brien-1993">{{Cite journal | last1 = O'Brien | first1 = JF. | last2 = Meade | first2 = JL. | last3 = Falk | first3 = JL. | title = Dexamethasone as adjuvant therapy for severe acute pharyngitis. | journal = Ann Emerg Med | volume = 22 | issue = 2 | pages = 212-5 | month = Feb | year = 1993 | doi = | PMID = 8427434 }}</ref><ref name="Bulloch-2003">{{Cite journal | last1 = Bulloch | first1 = B. | last2 = Kabani | first2 = A. | last3 = Tenenbein | first3 = M. | title = Oral dexamethasone for the treatment of pain in children with acute pharyngitis: a randomized, double-blind, placebo-controlled trial. | journal = Ann Emerg Med | volume = 41 | issue = 5 | pages = 601-8 | month = May | year = 2003 | doi = 10.1067/mem.2003.136 | PMID = 12712025 }}</ref><ref name="Marvez-Valls-2002">{{Cite journal | last1 = Marvez-Valls | first1 = EG. | last2 = Stuckey | first2 = A. | last3 = Ernst | first3 = AA. | title = A randomized clinical trial of oral versus intramuscular delivery of steroids in acute exudative pharyngitis. | journal = Acad Emerg Med | volume = 9 | issue = 1 | pages = 9-14 | month = Jan | year = 2002 | doi = | PMID = 11772663 }}</ref><ref name="Roy-2004">{{Cite journal | last1 = Roy | first1 = M. | last2 = Bailey | first2 = B. | last3 = Amre | first3 = DK. | last4 = Girodias | first4 = JB. | last5 = Bussières | first5 = JF. | last6 = Gaudreault | first6 = P. | title = Dexamethasone for the treatment of sore throat in children with suspected infectious mononucleosis: a randomized, double-blind, placebo-controlled, clinical trial. | journal = Arch Pediatr Adolesc Med | volume = 158 | issue = 3 | pages = 250-4 | month = Mar | year = 2004 | doi = 10.1001/archpedi.158.3.250 | PMID = 14993084 }}</ref><ref name="Niland-2006">{{Cite journal | last1 = Niland | first1 = ML. | last2 = Bonsu | first2 = BK. | last3 = Nuss | first3 = KE. | last4 = Goodman | first4 = DG. | title = A pilot study of 1 versus 3 days of dexamethasone as add-on therapy in children with streptococcal pharyngitis. | journal = Pediatr Infect Dis J | volume = 25 | issue = 6 | pages = 477-81 | month = Jun | year = 2006 | doi = 10.1097/01.inf.0000219469.95772.3f | PMID = 16732143 }}</ref><ref name="Wing-2010">{{Cite journal | last1 = Wing | first1 = A. | last2 = Villa-Roel | first2 = C. | last3 = Yeh | first3 = B. | last4 = Eskin | first4 = B. | last5 = Buckingham | first5 = J. | last6 = Rowe | first6 = BH. | title = Effectiveness of corticosteroid treatment in acute pharyngitis: a systematic review of the literature. | journal = Acad Emerg Med | volume = 17 | issue = 5 | pages = 476-83 | month = May | year = 2010 | doi = 10.1111/j.1553-2712.2010.00723.x | PMID = 20536799 }}</ref><ref name="Hayward-2012">{{Cite journal | last1 = Hayward | first1 = G. | last2 = Thompson | first2 = MJ. | last3 = Perera | first3 = R. | last4 = Glasziou | first4 = PP. | last5 = Del Mar | first5 = CB. | last6 = Heneghan | first6 = CJ. | title = Corticosteroids as standalone or add-on treatment for sore throat. | journal = Cochrane Database Syst Rev | volume = 10 | issue = | pages = CD008268 | month = | year = 2012 | doi = 10.1002/14651858.CD008268.pub2 | PMID = 23076943 }}</ref>Since there are safer and more effective alternatives than glucocorticoids for pain relief and their long term use come with a few side effects they not recommended for symptomatic relief of throat pain.However in a few conditions like infectious mononucleosis a short term may be help in alleviating pain.
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| ====Antibiotic therapy====
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| =====Acute Group A streptococal infection=====
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| *Antibiotics should be used with caution in patients of pharyngitis as all patients do not necesarily need it . They may also cause some undesired complications or side effects. The rationale behind prescribing antibiotics is to prevent complications and secondary infections.<ref name="Thomas-2000">{{Cite journal | last1 = Thomas | first1 = M. | last2 = Del Mar | first2 = C. | last3 = Glasziou | first3 = P. | title = How effective are treatments other than antibiotics for acute sore throat? | journal = Br J Gen Pract | volume = 50 | issue = 459 | pages = 817-20 | month = Oct | year = 2000 | doi = | PMID = 11127175 }}</ref><ref name="Spinks-2013">{{Cite journal | last1 = Spinks | first1 = A. | last2 = Glasziou | first2 = PP. | last3 = Del Mar | first3 = CB. | title = Antibiotics for sore throat. | journal = Cochrane Database Syst Rev | volume = 11 | issue = | pages = CD000023 | month = | year = 2013 | doi = 10.1002/14651858.CD000023.pub4 | PMID = 24190439 }}</ref>.It may also allow for rapidly resuming usual activities and prevent spread to family, classmates, and other close contacts.<ref name="Lindbaek-2006">{{Cite journal | last1 = Lindbaek | first1 = M. | last2 = Francis | first2 = N. | last3 = Cannings-John | first3 = R. | last4 = Butler | first4 = CC. | last5 = Hjortdahl | first5 = P. | title = Clinical course of suspected viral sore throat in young adults: cohort study. | journal = Scand J Prim Health Care | volume = 24 | issue = 2 | pages = 93-7 | month = Jun | year = 2006 | doi = 10.1080/02813430600638227 | PMID = 16690557 }}</ref>
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| *Antibiotics are only needed or prescribed prophylactically for Group A beta-hemolytic streptococci (GAS) .Antibiotics may help in decreasing the duration of symptoms but a few studies have shown that analgesic have the a similiar or better effect .<ref name="Thomas-2000">{{Cite journal | last1 = Thomas | first1 = M. | last2 = Del Mar | first2 = C. | last3 = Glasziou | first3 = P. | title = How effective are treatments other than antibiotics for acute sore throat? | journal = Br J Gen Pract | volume = 50 | issue = 459 | pages = 817-20 | month = Oct | year = 2000 | doi = | PMID = 11127175 }}</ref><ref name="Bradley-2000">{{Cite journal | last1 = Bradley | first1 = CP. | title = Taking another look at the acute sore throat. | journal = Br J Gen Pract | volume = 50 | issue = 459 | pages = 780-1 | month = Oct | year = 2000 | doi = | PMID = 11127165 }}</ref>
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| *Antibiotics are prescribed for streptococcal pharyngitis to prevent suppurative infections like [[peritonsilar abscess]], [[cervical lymphadenitis ]], [[mastoiditis]] and other invasive infections and non suppurative disorders like [[acute rheumatic fever]] and [[post streptococcal glomerulonephritis]].
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| *Inappropriate or overzealous use of antibiotics for treatment of pharyngitis is the major cause to antibiotic resistance.<ref name="Linder-2005">{{Cite journal | last1 = Linder | first1 = JA. | last2 = Bates | first2 = DW. | last3 = Lee | first3 = GM. | last4 = Finkelstein | first4 = JA. | title = Antibiotic treatment of children with sore throat. | journal = JAMA | volume = 294 | issue = 18 | pages = 2315-22 | month = Nov | year = 2005 | doi = 10.1001/jama.294.18.2315 | PMID = 16278359 }}</ref><ref name="Linder-2006">{{Cite journal | last1 = Linder | first1 = JA. | last2 = Chan | first2 = JC. | last3 = Bates | first3 = DW. | title = Evaluation and treatment of pharyngitis in primary care practice: the difference between guidelines is largely academic. | journal = Arch Intern Med | volume = 166 | issue = 13 | pages = 1374-9 | month = Jul | year = 2006 | doi = 10.1001/archinte.166.13.1374 | PMID = 16832002 }}</ref><ref name="McCaig-2002">{{Cite journal | last1 = McCaig | first1 = LF. | last2 = Besser | first2 = RE. | last3 = Hughes | first3 = JM. | title = Trends in antimicrobial prescribing rates for children and adolescents. | journal = JAMA | volume = 287 | issue = 23 | pages = 3096-102 | month = Jun | year = 2002 | doi = | PMID = 12069672 }}</ref>
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| Following are the guidelines for treatment of acute group A streptococci pharyngitis.
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| ! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099| Acute Group A Streptococcal Pharyngitis}}
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| ! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
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| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pencillin]] V oral children: 250 mg twice daily or 3 times daily
| | ! style="width: 34%;" | '''Supportive Therapies''' |
| '''adolescents and adults: 250 mg 4 times daily or 500 mg twice daily for 10 days'''''''' | | ! style="width: 33%;" | '''Systemic Therapy''' |
| | ! style="width: 33%;" | '''Antimicrobial Regimens''' |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR | | | valign="top" | |
| |-
| | '''Topical therapy''' |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin]] 50 mg/kg once daily (max = 1000 mg) alternate:
| | * Oral rinses were more effective in treating conditions affecting oral cavity and base of the tongue whereas sprays were more effective in coating the [[posterior pharynx]] and hence they were used to treat posterior pharynx conditions.<ref name="pmid10767923">Patel SK, Ghufoor K, Jayaraj SM, McPartlin DW, Philpott J (1999) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10767923 Pictorial assessment of the delivery of oropharyngeal rinse versus oropharyngeal spray.] ''J Laryngol Otol'' 113 (12):1092-4. PMID: [https://pubmed.gov/10767923 10767923]</ref> |
| '''25 mg/kg (max = 500 mg) twice daily for 10 days'''''''' | | '''Oral rinses''' |
| |-
| | *Saltwater gargles do not demonstrate any benefit in relieving throat pain. There are minimal side effects associated with these oral rinses. |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
| | *[[Lidocaine]], [[Diphenhydramine]] and [[Maalox]] ([[Aluminium hydroxide]], [[magnesium hydroxide]] and simethicone) have shown to be helpful. This combination can be used to treat Coxsackie A or B infection or herpes simplex. Avoid using the lidocaine over its recommended use.<ref name="pmid3382075">Hess GP, Walson PD (1988) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3382075 Seizures secondary to oral viscous lidocaine.] ''Ann Emerg Med'' 17 (7):725-7. PMID: [https://pubmed.gov/3382075 3382075]</ref><ref name="pmid7899121">Gonzalez del Rey J, Wason S, Druckenbrod RW (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7899121 Lidocaine overdose: another preventable case?] ''Pediatr Emerg Care'' 10 (6):344-6. PMID: [https://pubmed.gov/7899121 7899121]</ref> |
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| | *[[Benzydamine]] hydrochloride rinses have shown to help reduce the pain in a few cases. However, they are used more frequently to treat radiation mucositis.<ref name="pmid7600413">Turnbull RS (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7600413 Benzydamine Hydrochloride (Tantum) in the management of oral inflammatory conditions.] ''J Can Dent Assoc'' 61 (2):127-34. PMID: [https://pubmed.gov/7600413 7600413]</ref><ref name="pmid11589263">Passàli D, Volonté M, Passàli GC, Damiani V, Bellussi L, MISTRAL Italian Study Group (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11589263 Efficacy and safety of ketoprofen lysine salt mouthwash versus benzydamine hydrochloride mouthwash in acute pharyngeal inflammation: a randomized, single-blind study.] ''Clin Ther'' 23 (9):1508-18. PMID: [https://pubmed.gov/11589263 11589263]</ref> |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Benzathine Penicillin G]] I.M 27 kg: 600 000 U; ≥27 kg: 1 200 000 U 1 dose only'''''
| | '''Sprays''' |
| |-
| | *Topical [[anesthetic]] sprays have been used in the past to treat pharyngitis, however, their effect is not significant. They may also cause a few [[allergic]] reactions and side effects, such as [[methemoglobinemia]], and should not be used in children. |
| ! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
| | *[[Chlorhexidine]] / [[benzydamine]] sprays are more effective in alleviating symptoms of acute [[viral pharyngitis]] and group A streptococcal pharyngitis.<ref name="pmid21310101">Cingi C, Songu M, Ural A, Erdogmus N, Yildirim M, Cakli H et al. (2011) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21310101 Effect of chlorhexidine gluconate and benzydamine hydrochloride mouth spray on clinical signs and quality of life of patients with streptococcal tonsillopharyngitis: a multicentre, prospective, randomized, double-blinded, placebo-controlled study.] ''J Laryngol Otol'' 125 (6):620-5. [http://dx.doi.org/10.1017/S0022215111000065 DOI:10.1017/S0022215111000065] PMID: [https://pubmed.gov/21310101 21310101]</ref><ref name="pmid21086279">Cingi C, Songu M, Ural A, Yildirim M, Erdogmus N, Bal C (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21086279 Effects of chlorhexidine/benzydamine mouth spray on pain and quality of life in acute viral pharyngitis: a prospective, randomized, double-blind, placebo-controlled, multicenter study.] ''Ear Nose Throat J'' 89 (11):546-9. PMID: [https://pubmed.gov/21086279 21086279]</ref> |
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| | '''Lozenges''' |
| ! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''For individuals with penicillin allergy''
| | *Medical throat [[lozenges]] help reducing the duration of symptoms and also provide with some symptomatic relief. They are not recommended for children, as there is a risk of choking. [[Lozenges]] containing [[antiseptics]], [[menthol]], [[anesthetics]], and [[anti-inflammatory]] agents have been used.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref>. Flurbiprofen (trade name Strefen) lozenges may help<ref name="pmid11198725">Watson N, Nimmo WS, Christian J, Charlesworth A, Speight J, Miller K (2000) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11198725 Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomised, double-blind, placebo-controlled study of efficacy and safety.] ''Int J Clin Pract'' 54 (8):490-6. PMID: [https://pubmed.gov/11198725 11198725]</ref>. [[Amylmetacresol]] and [[2,4-Dichlorobenzylalcohol]] (AMC/DCBA) lozenges (trade names [[Strepsils]], [[Lorsept]], and [[Gorpils]]) may help<ref name="pmid28869700">{{cite journal| author=Weckmann G, Hauptmann-Voß A, Baumeister SE, Klötzer C, Chenot JF| title=Efficacy of AMC/DCBA lozenges for sore throat: A systematic review and meta-analysis. | journal=Int J Clin Pract | year= 2017 | volume= | issue= | pages= | pmid=28869700 | doi=10.1111/ijcp.13002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28869700 }} </ref>. |
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cephalexin]] oral 20 mg/kg/dose twice daily (max = 500 mg/dose)for 10 days'''''
| | '''Analgesics''' |
| |-
| | * [[Analgesics]] are prescribed for moderate to severe pain. [[Acetaminophen]], [[Nonsteroidal anti-inflammatory]] drugs ([[NSAID]]s) have shown to decrease pain symptoms. They may also help in reducing [[fever]] and [[inflammation]].<ref name="pmid11127175">Thomas M, Del Mar C, Glasziou P (2000) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11127175 How effective are treatments other than antibiotics for acute sore throat?] ''Br J Gen Pract'' 50 (459):817-20. PMID: [https://pubmed.gov/11127175 11127175]</ref><ref name="pmid17535039">Gehanno P, Dreiser RL, Ionescu E, Gold M, Liu JM (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17535039 Lowest effective single dose of diclofenac for antipyretic and analgesic effects in acute febrile sore throat.] ''Clin Drug Investig'' 23 (4):263-71. PMID: [https://pubmed.gov/17535039 17535039]</ref> [[Aspirin]] should be avoided in children as it may cause [[Reye's syndrome]]. For severe pain, [[codeine]] may be added to the [[NSAID]]. |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
| | '''Glucocorticoids''' |
| |-
| | * [[Glucocorticoid]]s may alleviate pain, and may also be beneficial in patients of [[Group A streptococcal pharyngitis]]. No benefits were obtained by adding single-dose [[glucocorticoid]] to [[antimicrobial]] therapy in children.<ref name="pmid15753273">Olympia RP, Khine H, Avner JR (2005) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15753273 Effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children.] ''Arch Pediatr Adolesc Med'' 159 (3):278-82. [http://dx.doi.org/10.1001/archpedi.159.3.278 DOI:10.1001/archpedi.159.3.278] PMID: [https://pubmed.gov/15753273 15753273]</ref><ref name="pmid8427434">O'Brien JF, Meade JL, Falk JL (1993) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8427434 Dexamethasone as adjuvant therapy for severe acute pharyngitis.] ''Ann Emerg Med'' 22 (2):212-5. PMID: [https://pubmed.gov/8427434 8427434]</ref><ref name="pmid12712025">Bulloch B, Kabani A, Tenenbein M (2003) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12712025 Oral dexamethasone for the treatment of pain in children with acute pharyngitis: a randomized, double-blind, placebo-controlled trial.] ''Ann Emerg Med'' 41 (5):601-8. [http://dx.doi.org/10.1067/mem.2003.136 DOI:10.1067/mem.2003.136] PMID: [https://pubmed.gov/12712025 12712025]</ref> Because there are safer and more effective alternatives than [[glucocorticoids]] for pain relief associated with fewer side effects, they not recommended for symptomatic relief of throat pain. |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefadroxil]] oral 30 mg/kg once daily (max = 1 g) for 10 days'''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR | |
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] oral 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days''''' | |
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Azithromycin]]oral 12 mg/kg once daily (max = 500 mg) for 5 days'''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clarithromycin]] oral 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days'''''
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| =====Chronic Carriers of Group A Streptococci===== | | | valign="top" | |
| | | '''Streptococcal pharyngitis'''<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> |
| Antimicrobial therapy is not indicated for majority of chronic carriers. A few conditions where antibiotics are recommended are:
| | *Preferred regimen (children): [[Penicillin V]] 250 mg PO bid-tid for 10 days |
| #An outbreak of [[rheumatic fever]], acute [[poststreptococcal glomerulonephritis]] or invasive GAS infection .
| | *Preferred regimen (adolescents and adults): [[Penicillin V]] 250 mg PO qid {{or}} 500 mg PO bid for 10 days |
| #Closed community outbreak of GAS pharyngitis.
| | *Alternative regimen (1): [[Amoxicillin]] 50 mg/kg PO qd for 10 days (maximum dose 1 g/day) {{or}} 25 mg/kg bid for 10 days (maximum dose 500 mg/day) |
| #Family history of acute rheumatic fever.
| | *Alternative regimen (2): [[Penicillin G|Benzathine Penicillin G]] 0.6 MU (<27 kg)/ 1.2 MU (≥27 kg) IM single dose |
| #Excessive anxiety about rheumatic fever
| | *Alternative regimen (3): [[Cephalexin]] 20 mg/kg PO bid for 10 days (maximum 500 mg/dose) |
| #If tonsillectomy in considered because of carriage.
| | *Alternative regimen (4): [[Cefadroxil]] 30 mg/kg PO qd for 10 days (maximum dose 1 g/day) |
| | | *Alternative regimen (5): [[Clindamycin]] 7 mg/kg PO tid for 10 days (maximum 300 mg/dose) |
| Following are the guidelines to treat a chonic carrier of Group A streptococci
| | *Alternative regimen (6): [[Clarithromycin]] 7.5 mg/kg PO bid for 10 days (maximum 250 mg/dose) |
| | | '''Other bacterial pharyngitis''' |
| {| class="wikitable" style="border: 2px solid #696969;"
| | *'''[[Arcanobacterium haemolyticum]]''': [[Erythromycin]] is the preferred drug.<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> |
| |-
| | *[[Neisseria gonorrhoeae]]: If uncomplicated<ref name="pmid11172144">Bisno AL (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11172144 Acute pharyngitis.] ''N Engl J Med'' 344 (3):205-11. [http://dx.doi.org/10.1056/NEJM200101183440308 DOI:10.1056/NEJM200101183440308] PMID: [https://pubmed.gov/11172144 11172144]</ref> |
| | valign=top |
| | **single dose of intramuscular [[ceftriaxone]] (125 mg) or a single dose of an oral [[quinolone]] ([[ciprofloxacin]], 500 mg, or [[ofloxacin]], 400 mg) + |
| {| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| | **single dose of [[azithromycin]] (1 g) or [[doxycycline]] (100 mg) twice daily for seven days for possible [[chlamydial]] [coinfection]] at genital sites. |
| ! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Chronic Carriers of Group A Streptococci}}
| | **[[Doxycycline]] and [[ofloxacin]] should not be prescribed for pregnant women. |
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| ! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 20–30 mg/kg/d in 3 doses (max = 300 mg/dose) for 10 days '''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin]] PLUS [[Rifampin]]; Penicillin V: 50 mg/kg/d in 4 doses × 10 d (max = 2000 mg/d) ;rifampin: 20 mg/kg/d in 1 dose × last 4 d of treatment (max = 600 mg/d) for 10 days '''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin–clavulanate]] 40 mg amoxicillin/kg/d in 3 doses (max = 2000 mg amoxicillin/d) for 10 days '''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Benzathine penicillin G]] (intramuscular) plus rifampin (oral) Benzathine penicillin G: 600 000 U for <27 kg and 1 200 000 U for ≥27 kg single dose; rifampin: 20 mg/kg/d in 2 doses (max = 600 mg/d) for 4 days'''''
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| |}
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| ====Alternate Therapy==== | | ==Chronic Carriers of Group A Streptococci== |
| | | Antimicrobial therapy is not indicated for the majority of chronic carriers. A few conditions where antibiotics are recommended are: |
| A few products are uses as a single agent or in combination to treat fever, pain and inflammation in pharyngitis. | | #An outbreak of [[rheumatic fever]], acute [[poststreptococcal glomerulonephritis]] or invasive GAS infection |
| | | #Closed community outbreak of GAS pharyngitis |
| ======Slippery elm======
| | #Family history of [[acute rheumatic fever]] |
| Due to its demulcent properties it is used to alleviate throat pain. It is used to treat a few infections and releive pain.
| | #Excessive anxiety about [[rheumatic fever]] |
| | |
| ======Serrapeptase======
| |
| A silkworm derivative which decrease bradykinin release is thought to have some antiinflammtory effect and hence useful in pharyngitis . Its proved to be safe and recommended for decreasing pain and inflammation in adults.No studies have shown them to be beneficial in children.Hence they are not supoposed to be used in children.<ref name="Mazzone-">{{Cite journal | last1 = Mazzone | first1 = A. | last2 = Catalani | first2 = M. | last3 = Costanzo | first3 = M. | last4 = Drusian | first4 = A. | last5 = Mandoli | first5 = A. | last6 = Russo | first6 = S. | last7 = Guarini | first7 = E. | last8 = Vesperini | first8 = G. | title = Evaluation of Serratia peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo. | journal = J Int Med Res | volume = 18 | issue = 5 | pages = 379-88 | month = | year = | doi = | PMID = 2257960 }}</ref>
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| ======Andrographis======
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| Used widely to treat health conditions of major organ systems like cardiovascular, gastrointestinal , hepatic , and upper respiratory infections . It use for 4 to 7 days is rendered safe in children.High dosage andrographis effects are similiar to acetaminophen in treating fever and sore throat.<ref name="Thamlikitkul-1991">{{Cite journal | last1 = Thamlikitkul | first1 = V. | last2 = Dechatiwongse | first2 = T. | last3 = Theerapong | first3 = S. | last4 = Chantrakul | first4 = C. | last5 = Boonroj | first5 = P. | last6 = Punkrut | first6 = W. | last7 = Ekpalakorn | first7 = W. | last8 = Boontaeng | first8 = N. | last9 = Taechaiya | first9 = S. | title = Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. | journal = J Med Assoc Thai | volume = 74 | issue = 10 | pages = 437-42 | month = Oct | year = 1991 | doi = | PMID = 1797953 }}</ref>A report shows its efficacy to be better than placebo and Echinacea if used with Siberian ginseng (Eleutherococcus senticosus) for treating cold symptoms. Andrographis use is still not recommended in treating pharyngitis in children.<ref name="Spasov-2004">{{Cite journal | last1 = Spasov | first1 = AA. | last2 = Ostrovskij | first2 = OV. | last3 = Chernikov | first3 = MV. | last4 = Wikman | first4 = G. | title = Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. | journal = Phytother Res | volume = 18 | issue = 1 | pages = 47-53 | month = Jan | year = 2004 | doi = 10.1002/ptr.1359 | PMID = 14750201 }}</ref>
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| * For treating cold symptoms in adult 400 mg dose three time a day is the recommended dose.<ref name="Cáceres-1999">{{Cite journal | last1 = Cáceres | first1 = DD. | last2 = Hancke | first2 = JL. | last3 = Burgos | first3 = RA. | last4 = Sandberg | first4 = F. | last5 = Wikman | first5 = GK. | title = Use of visual analogue scale measurements (VAS) to asses the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. | journal = Phytomedicine | volume = 6 | issue = 4 | pages = 217-23 | month = Oct | year = 1999 | doi = 10.1016/S0944-7113(99)80012-9 | PMID = 10589439 }}</ref>
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| * For treating tonsillopharyngitis in adults 3 to 6 gms daily is the recommended dose.
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| ======Honey-B-Anise======
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| Honey-B-Anise which includes bee propolis have shown to have some antiinflammatory property and also helps in reducing pain and inflammation .They do have a preponderance of allergic reaction .<ref name="Magro-Filho-1994">{{Cite journal | last1 = Magro-Filho | first1 = O. | last2 = de Carvalho | first2 = AC. | title = Topical effect of propolis in the repair of sulcoplasties by the modified Kazanjian technique. Cytological and clinical evaluation. | journal = J Nihon Univ Sch Dent | volume = 36 | issue = 2 | pages = 102-11 | month = Jun | year = 1994 | doi = | PMID = 8083767 }}</ref>Its use is still not recommended in chilkdrean and to be totally avoided in infants due to the risk of Clostridium botulinum infection.
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Emergency medicine]] | | [[Category:Emergency mdicine]] |
| [[Category:Primary care]] | | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
| [[Category:Inflammations]]
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| [[Category:Otolaryngology]] | | [[Category:Otolaryngology]] |
| [[Category:Pulmonology]] | | [[Category:Pediatrics]] |
| [[Category:Signs and symptoms]] | | [[Category:Immunology]] |
| [[Category:Needs overview]] | | [[Category:Gastroenterology]] |
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