Pediatrics, Pharyngitis Treatment & Management

  • Author: Harold K Simon, MD, MBA; Chief Editor: Richard G Bachur, MD   more...
 
Updated: May 21, 2010
 

Emergency Department Care

  • For patients with viral etiologies for their pharyngitis, care should be supportive, with antipyretics, analgesics, and measures to guarantee good hydration. IV fluids may be necessary.
  • For patients with GABHS, the criterion standard therapy is PCN. Based on the availability of rapid testing for GABHS and the clinical severity of the patient, one can decide between initiating therapy if a rapid test is positive for GABHS or delaying therapy until culture results are obtained if no rapid testing is available.
  • The issue of early versus delayed therapy for GABHS pharyngitis, until cultures can be obtained, has several considerations.
    • Early therapy (within 48 hours of symptoms) appears to shorten the duration of symptoms, limit the spread to others, allow the patient and family to return to their usual routine sooner, and limit losses to follow up.
    • Cons for early therapy before rapid GABHS screen or throat culture results can be obtained include the following:
      • Early therapy may lead to a higher failure rate secondary to an inability to create an immune response to the infection.
      • Rheumatic fever can be prevented even if antibiotic therapy is initiated as late as 9 days from the onset of symptoms.
      • Possible drug reactions may occur.
      • Expenses can be avoided by not immediately treating cases that are caused by pathogens other than GABHS.
    • Therefore, decisions on treatment must be individualized based on available testing, severity of symptoms, comfort with the availability to arrange follow-up care, and the need for the patient and the family to quickly return to their regular routine (eg, school, daycare).
Next

Consultations

  • Refer to ear, nose, and throat (ENT) specialist for possible tonsillectomy if pharyngitis is recurrent or severe.
  • Refer to the primary care physician for follow-up care.
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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, Director of Research, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston

Harold K Simon, MD, MBA is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Pediatric Society, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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.

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  Associate 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.

References

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