tonsillopharyngitis%20-%20acute%20(pediatric)
TONSILLOPHARYNGITIS - ACUTE (PEDIATRIC)
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) Treatment

Principles of Therapy

Symptomatic Treatment - Non Group A Beta-hemolytic Streptococcus (GABHS) infection
  • Symptomatic treatment is important in the management of children with sore throat
Symptomatic Treatment - Group A Beta-hemolytic Streptococcus (GABHS) infection
  • Important in the management of children with sore throat
  • Same as for non-GABHS infection
Antimicrobial Therapy
  • Treatment started only for documented GABHS infection
  • Due to practical constraints, antibiotics may be started empirically if:
    • GABHS is clinically suspected
    • Patient is toxic-looking
    • Follow-up is not possible
  • Empiric treatment of GABHS is discouraged due to poor diagnostic accuracy even with elaborate clinical scoring systems
  • A rapid antigen detection test (RADT) or throat swab should be taken before starting empiric antibiotics
  • If antibiotics are started empirically, and culture results are negative, the antibiotic should be discontinued
  • Appropriate antibiotics prevent acute rheumatic fever (ARF), prevent suppurative complications, decrease infectivity and shorten clinical course

Pharmacotherapy

Non-group A beta-hemolytic Streptococcus (Non-GABHS) Infectoin

Simple Analgesics / Antipyretics
  • Paracetamol is the drug of choice for analgesia in sore throat
  • Aspirin is not recommended due to the risk of Reye’s syndrome
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
  • Ibuprofen is a safe and effective alternative for analgesia and antipyrexia
  • Diclofenac may also be used for against pain caused by acute tonsillopharyngitis (ATP)
  • As NSAIDs are associated with significant risk of gastrointestinal bleeding (GI) bleeding, their routine use is not recommended
Throat Lozenges/Gargle/Spray
  • May be helpful especially in those with significant throat pain or discomfort
Group A beta-hemolytic Streptococcus (GABHS) Infection

Penicillin
  • Drug of choice
  • Proven efficacy, narrow spectrum, safety and low cost
  • Full 10-day course of treatment for oral medications
  • Intramuscular (IM) penicillin may be advisable if poor compliance is a concern
Amoxicillin
  • Better tolerated than Penicillin
  • 2nd line to Penicillin in pediatric patients due to taste preference
Macrolides
  • Eg Azithromycin, Clarithromycin, Erythromycin, Roxithromycin
  • May be used for patients with Penicillin allergy
  • Local resistance patterns should be included in the consideration for an alternative antibiotic in Penicillin-allergic patients
    • Resistance rate in Taiwan is approximately 10%
  • Azithromycin or Cephalexin may be used for Erythromycin-intolerant patients
Cephalosporins
  • Eg Cefaclor, Cefadroxil, Cefdinir, Cefixime, Cefpodoxime, Cephalexin
  • Alternative to Amoxicillin for the eradication of streptococcal infection especially in recurrent cases
  • Studies show that a 5-day treatment with a cephalosporin is superior to a 10-day course with Penicillin
Clindamycin
  • May be used for those who are both Penicillin-allergic and Erythromycin-intolerant
    • Resistance rate in Taiwan is approximately 10%
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