Pediatrics, Pharyngitis Follow-up
- Author: Harold K Simon, MD, MBA; Chief Editor: Richard G Bachur, MD more...
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 any of these over-the-counter medications, they should be taken on a limited basis and duration (no more than 2-3 days) following all package inserts and recommendations for dosing, delivery and usage. Patients should also consult their physician/care provider with any questions or concerns)
- 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
Complications of pharyngitis may include the following:
- Systemic infection
- Septicemia or toxic shock syndrome
- 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.
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