Sore throat resident survival guide (pediatrics)

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

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	Sensitivity (%)	Specificity (%)
Absence of cough	51-79	36-68
Anterior cervical nodes swollen or enlarged	55-82	34-73
Headache	48	50-80
Myalgia	49	60
Palatine petechiae	7	95
Pharyngeal exudates	26	88
Fever >38°C	22-58	52-92
Tonsillar exudate	36	85

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

Reference	Clinical signs and symptoms	Sensibility (%)	Specificity (%)
[37]	Recent exposure to GABHS, pharyngeal exudate, enlarged or tender cervical nodes, fever	55	74
[38]	Season, age, white cells count, fever, absence of cough, enlarged cervical nodes, tonsillar exudate or swelling	68	85
[39]	Swollen and tender anterior cervical nodes, tonsillar exudate	84	40
[40]	Fever, cervical nodes enlargement, tonsillar exudate or swelling or hypertrophy, Absence of cough	63	67
[41]	Season, age, fever, enlarged cervical nodes, tonsillar exudate or swelling or hypertrophy, absence of cough or rhinitis or conjunctivitis	22	93
[42]	Tonsillar hypertrophy, enlarged cervical nodes, absence of rhinitis, scarlet fever rash	18	97

=== 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 (Tylenol, others) 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 (sample brand name: Tylenol) or a nonsteroidal anti-inflammatory agent such as ibuprofen (sample brand names: Advil, Motrin).The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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

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