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Bacterial Pharyngitis Follow-up

  • Author: Maria A Carrillo-Marquez, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Mar 17, 2016
 

Further Outpatient Care

Patients with bacterial pharyngitis should be kept out of daycare, school, or work until 24 hours after the initiation of antibiotics.

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Further Inpatient Care

Droplet precautions should be observed until 24 hours after the initiation of antibiotics.

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Complications

GABHS infection may result in suppurative or nonsuppurative complications.

Local complications: These result from untreated infection that spreads to adjacent sites. Some of the more common of these suppurative infections include retropharyngeal abscess, peritonsillar abscess, sinusitis, cervical lymphadenitis, otitis media, and mastoiditis.

Acute rheumatic fever: This disorder usually occurs 2-4 weeks after an episode of pharyngitis. Administration of proper antibiotics up to 9 days after the onset of pharyngeal symptoms has been shown to prevent this manifestation.[58] Major manifestations of acute rheumatic fever include carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. Minor criteria include fever, polyarthralgia, elevated leukocyte count, elevated erythrocyte sedimentation rate, and prolonged P-R interval. Current incidence of this complication after endemic infection is unknown but believed to be substantially less than 1%.[59]

Rheumatic heart disease: This is the chronic valvular manifestation of acute rheumatic fever. The mitral valve is the site most often affected, and either regurgitation or stenosis may result.[60] In individuals with rheumatic heart disease, long-term secondary prophylaxis, often with benzathine penicillin, decreases the risk of subsequent episodes of acute rheumatic fever and further heart damage.

Poststreptococcal glomerulonephritis: This usually occurs 1-3 weeks following GABHS pharyngitis. Poststreptococcal glomerulonephritis, which may also follow a GABHS skin infection, has not been shown to be preventable with proper administration of antibiotics. Patients often present with hematuria, edema, and hypertension.

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Prognosis

GABHS pharyngitis is usually a self-limited illness. Throat symptoms resolve within 3-4 days in untreated patients. Administration of penicillin shortly after disease onset may shorten symptoms by 1-2 days.[61]

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Patient Education

Symptomatic relief may be provided by warm saline gargles, throat lozenges, and ibuprofen.

Acetaminophen or ibuprofen can be used for fever relief.

Patients with bacterial pharyngitis should be instructed to complete a full course of antibiotics, even if symptoms resolve.

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Contributor Information and Disclosures
Author

Maria A Carrillo-Marquez, MD Assistant Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases, Sanford Children's Specialty Clinic, Sanford School of Medicine, The University of South Dakota; Director, Pediatrics Residency Infectious Disease Rotation, Sanford Children’s Hospital

Maria A Carrillo-Marquez, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America, South Dakota State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Kenneth C Earhart, MD Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3

Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Eric S Halsey, MD Head, Virology Department, Naval Medical Research Unit No. 6, Lima, Peru; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Eric S Halsey, MD is a member of the following medical societies: Armed Forces Infectious Diseases Society, HIV Medicine Association of America, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Kelley Struble, DO Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine

Kelley Struble, DO is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Gordon L Woods, MD Consulting Staff, Department of Internal Medicine, University Medical Center

Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine

Disclosure: Nothing to disclose.

Acknowledgments

The authors wish to thank Donald Minnich and Dennis Clark for the preparation and photography of the microbiology specimens.

References
  1. [Guideline] Shulman ST, Bisno AL, Clegg HW, et al. 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. 2012 Nov 15. 55(10):1279-82. [Medline].

  2. Spellerberg B, Brandt C. Streptococcus. Manual of Clinical Microbiology. 9th edition. 2007. 412-29.

  3. Guilherme L, Kalil J, Cunningham M. Molecular mimicry in the autoimmune pathogenesis of rheumatic heart disease. Autoimmunity. 2006 Feb. 39(1):31-9. [Medline].

  4. Dale JB. Current status of group A streptococcal vaccine development. Adv Exp Med Biol. 2008. 609:53-63. [Medline].

  5. Stollerman GH, Dale JB. The importance of the group a streptococcus capsule in the pathogenesis of human infections: a historical perspective. Clin Infect Dis. 2008 Apr 1. 46(7):1038-45. [Medline].

  6. Sriskandan S, Faulkner L, Hopkins P. Streptococcus pyogenes: Insight into the function of the streptococcal superantigens. Int J Biochem Cell Biol. 2007. 39(1):12-9. [Medline].

  7. Musher DM. How contagious are common respiratory tract infections?. N Engl J Med. 2003 Mar 27. 348(13):1256-66. [Medline].

  8. Brook I, Gober AE. Persistence of group A beta-hemolytic streptococci in toothbrushes and removable orthodontic appliances following treatment of pharyngotonsillitis. Arch Otolaryngol Head Neck Surg. 1998 Sep. 124(9):993-5. [Medline].

  9. Roos K, Lind L, Holm SE. Beta-haemolytic streptococci group A in a cat, as a possible source of repeated tonsillitis in a family. Lancet. 1988 Nov 5. 2(8619):1072. [Medline].

  10. Wilson KS, Maroney SA, Gander RM. The family pet as an unlikely source of group A beta-hemolytic streptococcal infection in humans. Pediatr Infect Dis J. 1995 May. 14(5):372-5. [Medline].

  11. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. Natl Health Stat Report. 2008 Aug 6. 1-29. [Medline].

  12. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005 Nov. 5(11):685-94. [Medline].

  13. Pfoh E, Wessels MR, Goldmann D, Lee GM. Burden and economic cost of group A streptococcal pharyngitis. Pediatrics. 2008 Feb. 121(2):229-34. [Medline].

  14. Alter SJ, Vidwan NK, Sobande PO, Omoloja A, Bennett JS. Common childhood bacterial infections. Curr Probl Pediatr Adolesc Health Care. 2011 Nov. 41(10):256-83. [Medline].

  15. Centor RM, Allison JJ, Cohen SJ. Pharyngitis management: defining the controversy. J Gen Intern Med. 2007 Jan. 22(1):127-30. [Medline].

  16. Gerber MA, Randolph MF, Martin NJ, Rizkallah MF, Cleary PP, Kaplan EL. Community-wide outbreak of group G streptococcal pharyngitis. Pediatrics. 1991 May. 87(5):598-603. [Medline].

  17. Cohen D, Ferne M, Rouach T, Bergner-Rabinowitz S. Food-borne outbreak of group G streptococcal sore throat in an Israeli military base. Epidemiol Infect. 1987 Oct. 99(2):249-55. [Medline]. [Full Text].

  18. Stryker WS, Fraser DW, Facklam RR. Foodborne outbreak of group G streptococcal pharyngitis. Am J Epidemiol. 1982 Sep. 116(3):533-40. [Medline].

  19. Turner JC, Hayden FG, Lobo MC, Ramirez CE, Murren D. Epidemiologic evidence for Lancefield group C beta-hemolytic streptococci as a cause of exudative pharyngitis in college students. J Clin Microbiol. 1997 Jan. 35(1):1-4. [Medline].

  20. Zaoutis T, Attia M, Gross R, Klein J. The role of group C and group G streptococci in acute pharyngitis in children. Clin Microbiol Infect. 2004 Jan. 10(1):37-40. [Medline].

  21. Llor C, Madurell J, Balagué-Corbella M, Gómez M, Cots JM. Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial. Br J Gen Pract. 2011 May. 61(586):e244-51. [Medline]. [Full Text].

  22. Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24. 119(11):1541-51. [Medline].

  23. Shah M, Centor RM, Jennings M. Severe acute pharyngitis caused by group C streptococcus. J Gen Intern Med. 2007 Feb. 22(2):272-4. [Medline].

  24. American Academy of Pediatrics. Arcanobacterium haemolyticum Infections. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 238-9.

  25. Miller RA, Brancato F, Holmes KK. Corynebacterium hemolyticum as a cause of pharyngitis and scarlatiniform rash in young adults. Ann Intern Med. 1986 Dec. 105(6):867-72. [Medline].

  26. Morris SR, Klausner JD, Buchbinder SP, et al. Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study. Clin Infect Dis. 2006 Nov 15. 43(10):1284-9. [Medline].

  27. Holder NA. Gonococcal infections. Pediatr Rev. 2008 Jul. 29(7):228-34. [Medline].

  28. Papp JR, Ahrens K, Phillips C, Kent CK, Philip S, Klausner JD. The use and performance of oral-throat rinses to detect pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections. Diagn Microbiol Infect Dis. 2007 Nov. 59(3):259-64. [Medline].

  29. Centers for Disease Control and Prevention. Press Release. First-line Oral Gonorrhea Treatment Available Again in United States. April 25, 2008.

  30. Esposito S, Blasi F, Bosis S, et al. Aetiology of acute pharyngitis: the role of atypical bacteria. J Med Microbiol. 2004 Jul. 53:645-51. [Medline].

  31. Sendi P, Graber P, Lepere F, Schiller P, Zimmerli W. Mycoplasma pneumoniae infection complicated by severe mucocutaneous lesions. Lancet Infect Dis. 2008 Apr. 8(4):268. [Medline].

  32. Arbaji A, Kharabsheh S, Al-Azab S, et al. A 12-case outbreak of pharyngeal plague following the consumption of camel meat, in north-eastern Jordan. Ann Trop Med Parasitol. 2005 Dec. 99(8):789-93. [Medline].

  33. American Academy of Pediatrics. Tularemia. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 768-9.

  34. American Academy of Pediatrics. Diphtheria. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 307-11.

  35. Amess JA, O'Neill W, Giollariabhaigh CN, Dytrych JK. A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital. Br J Biomed Sci. 2007. 64(2):63-5. [Medline].

  36. American Academy of Pediatrics. Fusobacterium Infections. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 331-2.

  37. Batty A, Wren MW. Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs. Br J Biomed Sci. 2005. 62(2):66-70. [Medline].

  38. Jensen A, Hagelskjaer Kristensen L, Prag J. Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by real-time PCR. Clin Microbiol Infect. 2007 Jul. 13(7):695-701. [Medline].

  39. Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am. 2005 Jun. 52(3):729-47, vi. [Medline].

  40. Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics. 2009 Feb. 123(2):437-44. [Medline].

  41. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev. 2004 Jul. 17(3):571-80, table of contents. [Medline].

  42. Salkind AR, Wright JM. Economic Burden of Adult Pharyngitis: The Payer's Perspective. Value Health. 2007 Dec 17. [Medline].

  43. Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic MV, Al Othman MA. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev. 2009 Jan 21. CD004872. [Medline].

  44. Lennon DR, Farrell E, Martin DR, Stewart JM. Once-daily amoxicillin versus twice-daily penicillin V in group A beta-haemolytic streptococcal pharyngitis. Arch Dis Child. 2008 Jun. 93(6):474-8. [Medline].

  45. Clegg HW, Ryan AG, Dallas SD, et al. Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial. Pediatr Infect Dis J. 2006 Sep. 25(9):761-7. [Medline].

  46. Shvartzman P, Tabenkin H, Rosentzwaig A, Dolginov F. Treatment of streptococcal pharyngitis with amoxycillin once a day. BMJ. 1993 May 1. 306(6886):1170-2. [Medline]. [Full Text].

  47. van Driel ML, De Sutter AI, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2010 Oct 6. CD004406. [Medline].

  48. Pichichero ME, Casey JR. Bacterial eradication rates with shortened courses of 2nd- and 3rd-generation cephalosporins versus 10 days of penicillin for treatment of group A streptococcal tonsillopharyngitis in adults. Diagn Microbiol Infect Dis. 2007 Oct. 59(2):127-30. [Medline].

  49. Lakoš AK, Gašparic M, Kovacic D, Pangercic A, Kukuruzovic MM, Baršic B. Safety and effectiveness of azithromycin in the treatment of respiratory infections in children. Curr Med Res Opin. 2011 Dec 1. [Medline].

  50. Chan DS, Demers DM, Bass JW. Antimicrobial liquid formulations: a blind taste comparison of three brands of penicillin VK and three brands of amoxicillin. Ann Pharmacother. 1996 Feb. 30(2):130-2. [Medline].

  51. Gruchalla RS, Pirmohamed M. Clinical practice. Antibiotic allergy. N Engl J Med. 2006 Feb 9. 354(6):601-9. [Medline].

  52. Richter SS, Heilmann KP, Beekmann SE, et al. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis. 2005 Sep 1. 41(5):599-608. [Medline].

  53. Malhotra-Kumar S, Lammens C, Chapelle S, et al. Macrolide- and telithromycin-resistant Streptococcus pyogenes, Belgium, 1999-2003. Emerg Infect Dis. 2005 Jun. 11(6):939-42. [Medline].

  54. Tanz RR, Shulman ST, Shortridge VD, et al. Community-based surveillance in the united states of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis. 2004 Dec 15. 39(12):1794-801. [Medline].

  55. Kaplan EL. The group A streptococcal upper respiratory tract carrier state: an enigma. J Pediatr. 1980 Sep. 97(3):337-45. [Medline].

  56. Orvidas LJ, St Sauver JL, Weaver AL. Efficacy of tonsillectomy in treatment of recurrent group A beta-hemolytic streptococcal pharyngitis. Laryngoscope. 2006 Nov. 116(11):1946-50. [Medline].

  57. [Guideline] Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011 Jan. 144(1 Suppl):S1-30. [Medline].

  58. Catanzaro FJ, Stetson CA, Morris AJ, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med. 1954 Dec. 17(6):749-56. [Medline].

  59. American Academy of Pediatrics. Group A Streptococcal Infections. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 668-80.

  60. Steer AC, Danchin MH, Carapetis JR. Group A streptococcal infections in children. J Paediatr Child Health. 2007 Apr. 43(4):203-13. [Medline].

  61. Dagnelie CF, van der Graaf Y, De Melker RA. Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice. Br J Gen Pract. 1996 Oct. 46(411):589-93. [Medline].

  62. Kassutto S, Rosenberg ES. Primary HIV type 1 infection. Clin Infect Dis. 2004 May 15. 38(10):1447-53. [Medline].

 
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Picture of Streptococcus pyogenes at 100 X magnification.
Rapid antigen detection test for group A beta-hemolytic streptococci.
Posterior pharynx with petechiae and exudates in a 12-year-old girl. Both the rapid antigen detection test and throat culture were positive for group A beta-hemolytic Streptococcus.
Throat swab. Video courtesy of Therese Canares, MD; Marleny Franco, MD; and Jonathan Valente, MD (Rhode Island Hospital, Brown University).
 
 
 
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