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

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

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

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Bacteria

• Streptococcus( group A beta-haemolytic )
• 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 [5]

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

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

Centor Score [24].

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

penicillin is first choice treatment, 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

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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