Tonsillopharyngitis is the inflammation of the tonsils and pharynx.
Etiologies include bacterial and viral pathogens.
Sore throat is the most common presenting symptom in older children.


Centor Criteria
  • Used to assess the susceptibility of patients to group A beta-hemolytic streptococcus (GABHS) infection based on the patient’s age and symptoms
    • Results may assist in the decision to start antibiotic treatment
  • Uses a points system utilizing the following signs/symptoms:
  • Fever (>38oC) (1)
  • Absence of cough (1)
  • Tender anterior cervical node (1)
  • Tonsillar exudate/swelling (1)
  • Age 3-14 years (1)
  • Age 15-44 years (0)
  • Age >44 years (-1)
  • Modified total risk based on total ATP score:
  • Total score Risk of group A beta-hemolytic streptococcus (GABHS)
    ≥4 51-53%
    3 28-35%
    2 11-17%
    13 5-10%
    ≤0 1-2.5%


Evaluation for complications
  • Patients with sore throat may have deep neck infections including epiglottitis, peritonsillar or retropharyngeal abscess
  • Examine for signs of upper airway obstruction
Evaluation for group A beta-hemolytic streptococcus (GABHS) infection
  • Identify & treat GABHS infection to decrease risk of complications like acute rheumatic fever (ARF), glomerulonephritis, pediatric autoimmune neuropsychiatric disorders associated w/ streptococcal infection (PANDAS) syndrome, & decrease period of contagiousness
  • GABHS is the most common bacterial pathogen of ATP & warrants antibiotic treatment
  • GABHS infection should be suspected on clinical & epidemiological grounds & supported by lab tests
  • Viral pathogens are more frequent than bacteria, accounting for about 70-90% of cases in children, & almost 100% in children <3 years of age
  • Tests not needed for patients whose features do not suggest GABHS infection
  • For patients 3-15 years of age, perform diagnostic tests when GABHS cannot be excluded

Laboratory Tests

Rapid Antigen Detection Test (RADT)
  • Advantage of speed (within minimum versus 48 hours for culture) & specificity (>95%) for group A beta-hemolytic streptococcus (GABHS)
  • Children with throat pain with ≥2 of the following are recommended to undergo RADT:
    • Absence of cough
    • Presence of tonsillar exudates/swelling
    • History of fever
    • Age >15 years
    • Positive for swelling & tenderness of the anterior cervical lymph nodes
  • Confirmation with culture is not necessary after a negative RADT result

Throat Swab Culture

  • Highly sensitive (90-95% sensitivity) but not done routinely because of delay in results (18-24 hours)
  • Throat swabs from both tonsils & posterior pharyngeal wall
  • Optimal time for collection is at onset of symptoms & before antibiotics are started
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