Treatment Guideline Chart
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.

Tonsillopharyngitis%20-%20acute%20(pediatric) Diagnosis


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%
FeverPAIN Score
  • May be used to assess the need to start antibiotic treatment as well as the severity of throat pain
  • High results may indicate streptococcal infection; results should be correlated with Centor criteria score


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 and treat GABHS infection as soon as possible after diagnosis to decrease risk of complications like acute rheumatic fever (ARF), glomerulonephritis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) syndrome, and decrease period of contagiousness
  • GABHS is the most common bacterial pathogen of ATP and warrants antibiotic treatment
  • GABHS infection should be suspected on clinical and epidemiological grounds and supported by lab tests
  • Viral pathogens are more frequent than bacteria, accounting for about 70-90% of cases in children, and 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%), and sensitivity (70-90%) 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 and 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 (24-48 hours)
    • Recommended for those with history of contact with symptomatic persons with GABHS pharyngitis, recurrent GABHS infection and symptomatic patients at high risk for rheumatic fever
  • Throat swabs from both tonsils and posterior pharyngeal wall
  • Optimal time for collection is at onset of symptoms and before antibiotics are started

Other Tests

  • Molecular assays [ie nucleic acid amplification tests, polymerase chain reaction (PCR)] and serologic testing for GABHS may also be considered
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