Sore throat resident survival guide (pediatrics)

Resident Survival Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Asia Alriashi, MD[2]

Synonyms and keywords:

Sore throat resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Sore throat is an acute upper respiratory tract infection that affects the respiratory mucosa of the throat.

Causes

if left untreated cause acute rheumatic fever (ARF), According to WHO, at least 15.6 million people have rheumatic heart disease (RHD), and 233 000 deaths annually are directly attributable to ARF. Due to the limitations of reports related to limited resources in developing countries, it is likely that the prevalence and incidence of ARF are largely underestimated.

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Croup
• Acute epiglottitis

Differentiating croup and epiglottitis

	Croup	Epiglottitis
Clinical features	Acute stridor with coughing and lack of drooling	Acute stridor with drooling and lack of coughing
Course	Slow-developing airway obstruction - rare severe obstruction	Rapidly courses with complete airway obstruction and shock
Imaging	Steeple sign in an anterior-posterior neck x-ray	Thumb sign in a lateral neck x-ray
Additional clinical features (less reliable for diagnostic)	Sore throat Barking cough	Sore throat Sitting position Refusal of food or drink Inability to swallow Vomiting
Treatment	Nebulization of racemic epinephrine: Preferred regimen: 0.5 mL of a 2.25% racemic epinephrine solution diluted in 3 mL of normal saline	Medical emergency: Invasive airway management (oral intubation or tracheotomy) Antibiotics Intensive care unit

Bacteria

• Streptococcus( group A beta-haemolytic ) most commonly
• Haemophilus influenzae
• Moraxella catarrhalis

viruses

• Rhinovirus
• coronavirus.
• respiratory syncytial virus.
• metapneumovirus.
• Epstein–Barr virus.

chemical irritation

• nasogastric tubes.
• smoke.

FIRE: Focused Initial Rapid Evaluation

=== Table 1=== Clinical signs and symptoms of GABSH pharingitis , their sensitivity and specificity

Symptoms and Clinical Findings
Absence of cough
Anterior cervical nodes swollen or enlarged
Headache
Myalgia
Palatine petechiae
Pharyngeal exudates
Fever >38°C
Tonsillar exudate

=== Table 2===[3] Clinical Score for GABSH pharyngitis.

	Clinical signs and symptoms
	Recent exposure to GABHS, pharyngeal exudate, enlarged or tender cervical nodes, fever
	Season, age, white cells count, fever, absence of cough, enlarged cervical nodes, tonsillar exudate or swelling
	Swollen and tender anterior cervical nodes, tonsillar exudate
	Fever, cervical nodes enlargement, tonsillar exudate or swelling or hypertrophy, Absence of cough
	Season, age, fever, enlarged cervical nodes, tonsillar exudate or swelling or hypertrophy, absence of cough or rhinitis or conjunctivitis
	Tonsillar hypertrophy, enlarged cervical nodes, absence of rhinitis, scarlet fever rash

=== Table 3 ===[3] Centor Score,

Clinical criteria	Points
Absence of cough	1
Swollen and tender anterior cervical nodes	1
Temperature > 38°C	1
Tonsillar exudate or swelling	1
Age 3 to 14 years	1
Age 15 to 44 years	0
Age 45 years and older	-1

Complete Diagnostic Approach"portal.nnpbc.com" (PDF).

• Rapid strep test (if available)

• Throat swab for culture and sensitivity

• If the child is greater than 2 years old, culture the throat before treatment or do rapid Strep antigen test (if available); if negative, do throat culture.

• Monospot if suspect vira

Treatment

A sore throat caused by a viral infection usually lasts five to seven days and doesn't require medical treatment"portal.nnpbc.com" (PDF)..

To ease pain and fever, many people turn to acetaminophen may be given every four to six hours as needed but should not be given more than five times in a 24-hour period.,) or other mild pain relievers..

if bacterial infection first choice treatment is penicillin , since GABHS remains universally susceptible to penicillin. Although penicillin V is the drug of choice, ampicillin or amoxicillin are good taste, represent a suitable option in children.

=== Table 4=== Therapeutic options for GABHS pharyngitis recommended by American Hearth Association and American Academy of Pediatrics AAP [13,4].

Drug	Dose	Duration
Penicillins
Penicillin V (oral)	• Children <27 kg: 400 000 U (250 mg) 2 to 3 times daily ; • Children >27 kg, adolescents, and adults: 800 000 (500 mg) 2 to 3 times daily	10 days
Amoxicillin (oral)	50 mg/kg once daily (maximum 1 g)	10 days
Benzathin Penicillin G (intramuscular)	• Children <27 kg: 600 000 U (375 mg); • Children >27 kg, adolescents, and adults: 1 200 000 U (750 mg)	Once
For individuals allergic to penicillin
Narrow-spectrum cephalosporin (cephalexin, cefadroxil) (oral)*	Variable	10 days
Clindamycin (oral)	20 mg/kg per day divided in 3 doses (maximum 1.8 g/d)	10 days
Azithromycin (oral)	12 mg/kg once daily (maximum 500 mg)	5 days
Clarithromycin (oral)	15 mg/kg per day divided BID (maximum 250 mg BID)	10 days

* Patients with immediate or type I hypersensitivity to penicillin should not be treated with a cephalosporin [4].

Do's

• Pain reliever :Throat pain can be treated with a mild pain reliever such as acetaminophen ( Tylenol) or a nonsteroidal anti-inflammatory agent such as ibuprofen ( Advil, Motrin)
• keep hydration:Drinking alot of fluid To reduce the risk of dehydration, parents can offer warm or cold liquids.
• Other intervention: include sipping warm beverages (eg, honey or lemon tea, chicken soup), cold beverages, or eating cold or frozen desserts (eg, ice cream, popsicles). These treatments are safe for children

Don'ts

• Aspirin is not recommended for children <18 years due to the risk of a potentially serious condition known as Reye syndrome.
• Sprays containing topical anesthetics are available to treat sore throat We do not recommend throat sprays for children.
• medicated throat lozenges are available to relieve dryness or pain it is not clear that lozenges work any better than hard candy. We do not recommend throat lozenges for children, especially children younger than five years, who can choke. Sucking on hard candy may provide some relief for children older than five years, who are not at risk for choking
• Honey should not be given to children younger than 12 months due to the potential risk of botulism poisoning.

References

https://www.wikidoc.org/index.php/Sore_throat_resident_survival_guide_(pediatrics)#cite_note-pmid21281502-3