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Tonsillopharyngitis%20-%20acute%20(pediatric) Treatment
Principles of Therapy
Symptomatic Treatment - Non Group A Beta-hemolytic Streptococcus (GABHS) infection
- Important in the management of children with sore throat
- Important in the management of children with sore throat
- Same as for non-GABHS infection
- 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
Penicillin
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
- 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
- May be helpful especially in those with significant throat pain or discomfort
- Candy lozenges should not be given to children ≤4 years of age due to choking hazard
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
- Better tolerated than Penicillin
- 2nd line to Penicillin in pediatric patients due to taste preference
- 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
- Eg Cefaclor, Cefadroxil, Cefdinir, Cefixime, Cefpodoxime, Cefuroxime, 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
- May be used for those who are both Penicillin-allergic and Erythromycin-intolerant
- Resistance rate in Taiwan is approximately 10%
