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Pediatrics, Pharyngitis: Follow-up

Author: Harold K Simon, MD, MBA, Professor of Pediatrics and Emergency Medicine, Associate Division Director of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta
Contributor Information and Disclosures

Updated: Jan 28, 2008

Follow-up

Further Inpatient Care

  • Rarely, small children with signs and symptoms of dehydration secondary to refusal to drink may require hospitalization for IV hydration.
  • Usually, even those patients who require IV hydration in the ED will take adequate oral fluids following their IV fluid bolus to allow home management.

Further Outpatient Care

  • Given that more than 90% of children clear GABHS from their pharynx within 24 hours of antibiotic therapy, they should remain out of school or daycare for 1 day.
  • If symptoms persist for greater than 24-48 hours, they should be re-evaluated for the possibility of other concerns as well as treatment failures.
  • Follow-up cultures are not routinely necessary unless concerns of recurrences or a carrier state exist.
  • Families should be instructed to encourage adequate hydration and antipyretics for pain and fever.
  • If worsening or signs of dehydration occur, patients should be instructed to seek immediate medical care or consultation with their primary medical provider.

Inpatient & Outpatient Medications

  • In addition to adequate antibiotic therapy for those with GABHS, all patients, irrespective of the etiology of their pharyngitis, should have antipyretics recommended for pain or fever.
    • Ibuprofen given at 10 mg/kg/dose PO q8h
    • Acetaminophen at 15 mg/kg/dose PO q4-6h
  • For patients with herpangina (stomatitis/pharyngitis), Maalox/Benadryl mixed 1:1 can be given PO before meals to decrease the associated discomfort and enhance good hydration. This can be dosed based on the Benadryl component at 1.25 mg/kg/dose PO, swish and swallow q6h prn.

Complications

  • Rheumatic fever
  • Poststreptococcal glomerulonephritis
  • Peritonsillar abscess
  • Systemic infection
  • Otitis media
  • Mastoiditis
  • Septicemia or toxic shock syndrome
  • Rhinitis
  • Sinusitis
  • Pneumonia

Prognosis

  • Streptococcal pharyngitis has a 5- to 7-day course.
    • Symptoms usually resolve spontaneously, without treatment; however, rheumatic complications are still possible.
    • Suppurative complications, such as a peritonsillar abscess, require surgical intervention.

Patient Education

  • Instruct on the importance of completing a 10-day course of antibiotics, regardless of symptom response.
  • For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education articles Sore Throat and Strep Throat.

Miscellaneous

Special Concerns

  • While treatment concerns for the prevention of rheumatic fever are the primary reason for treating GABHS, several interesting facts were found during recent outbreaks of rheumatic fever in 1985 and 1990.
    • No previous significant increases in GABHS were noted in the communities prior to the outbreaks.
    • The outbreaks were observed in middle class areas in which compliance rates with medical therapy are relatively high.
    • Unlike most prior outbreaks, severe pharyngitis rarely was noted and only 46% of patients reported even having a recent sore throat.
    • Only 24% of the patients felt they had sore throats that were significant enough for them to seek medical care.
    • Almost 20% of the cases were in children who received antibiotics for their pharyngitis (type of antibiotic, length of therapy, and compliance issues were unclear).
    • Therefore, outbreaks may in fact be most related to the rheumatogenic quality of the GABHS.
 


More on Pediatrics, Pharyngitis

Overview: Pediatrics, Pharyngitis
Differential Diagnoses & Workup: Pediatrics, Pharyngitis
Treatment & Medication: Pediatrics, Pharyngitis
Follow-up: Pediatrics, Pharyngitis
References
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References

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  2. Krober MS, Weir MR, Themelis NJ, et al. Optimal dosing interval for penicillin treatment of streptococcal pharyngitis. Clin Pediatr (Phila). Nov 1990;29(11):646-8. [Medline].

  3. American Academy of Pediatrics. Report of the committee on infectious diseases. In: Peter G, ed. Red Book. Elk Grove Village, AAP; & 1997 1994:430-9; 483-9.

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Further Reading

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Keywords

pharyngitis in children, pharyngitis, group A beta-hemolytic streptococcal pharyngitis, GABHS, group C streptococci, group G streptococci, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Corynebacterium hemolyticum, rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus, mononucleosis, cytomegalovirus, Staphylococcus aureus, Haemophilus influenzae, Branhamella catarrhalis, Bacteroides fragilis, Bacteroides oralis, Bacteroides melaninogenicus,Fusobacterium species, Peptostreptococcus species, Chlamydia trachomatis, Mycoplasma pneumoniae

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Contributor Information and Disclosures

Author

Harold K Simon, MD, MBA, Professor of Pediatrics and Emergency Medicine, Associate Division Director of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta
Harold K Simon, MD, MBA is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, Sigma Xi, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Health Service, Western Australia Country Health Service; Adjunct Associate Professor, School of Exercise, Biomedical and Health Sciences, Faculty of Computing, Health and Science, Edith Cowan University; Medical Director, St John Ambulance Service
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Assistant Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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