Pharyngitis Treatment & Management
- Author: John R Acerra, MD; Chief Editor: Pamela L Dyne, MD more...
See the list below:
- Prehospital care usually is not necessary for uncomplicated pharyngitis unless airway compromise is an issue.
- Intubation should not be attempted unless the patient stops breathing spontaneously.
Emergency Department Care
See the list below:
- Assess and secure the airway, if necessary.
- Assess the patient for signs of toxicity, epiglottitis, or oropharyngeal abscess.
- Evaluate the hydration status because severe pharyngitis limits oral intake. Appropriate measures to rehydrate should be initiated, including intravenous hydration.
- Assess for GAS infection if clinically suspected. A suggested algorithm as is follows.
- In general, patients should not be treated without a positive culture or positive rapid antigen detection test result because of increasing antibiotic resistance. Guidelines from the Infectious Diseases Society of America (IDSA) and American Heart Association state that microbiologic confirmation (via a rapid antigen test or culture) is required for the diagnosis of GAS.[9, 5]
- Perform rapid antigen detection test if GAS is clinically suspected based on history and physical examination. If positive, begin antibiotic therapy. Testing does not usually need to be performed on patients with acute pharyngitis whose clinical and epidemiologic features do not suggest GAS as the etiology (Centor score 0-1).
- Patients who are positive for all 4 Centor criteria can often be treated with antibiotics without antigen testing or cultures.
- Household contacts of patients with GAS infection or scarlet fever should be treated for a full 10 days of antibiotics without testing only if they have symptoms consistent with GAS. Asymptomatic contacts should not be treated.
- If clinically doubtful or the above criteria are not met, it is best to await rapid antigen or culture results to initiate antibiotic therapy.
A study by Cohen et al suggested that rules-based selective testing strategies for children with pharyngitis do not have a sufficient combination of sensitivity and specificity to determine which patients should be tested for group A streptococcal infection. Using an external validation cohort of 676 children, the investigators determined that none of the clinical prediction rules used in the study reached the investigators’ diagnostic accuracy target; specifically, a sensitivity and specificity of greater than 85%.
With a few exceptions, uncomplicated cases of pharyngitis should not require a consultation. Infectious disease specialists should be consulted in the case of unusual presentation or in the case of a patient who is immunocompromised.
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