Tonsillopharyngitis%20-%20acute Management

• Follow-up of asymptomatic patients after completion of antibiotic course is not typically necessary

Follow-up Cultures are Indicated in:

• Patients who remain symptomatic
• Patients whose symptoms recur
• Patients with history of rheumatic fever
• Patients who develop acute pharyngitis during outbreaks of either rheumatic fever or post-streptococcal glomerulonephritis, or during outbreaks of GABS pharyngitis in closed or partially closed communities
• Continual spread of infection within a family

The Following Should be Considered if Recurrent Episodes Occur:

• Persistence of group A Streptococcus carriage in the face of an intercurrent viral infection
• New group A streptococcus pharyngeal infection obtained from contacts
• Noncompliance with treatment regimen

Management of Recurrent Episodes of Acute Pharyngitis

Single Episode with Laboratory Confirmation Shortly After Completion of Antibiotic Course

• Re-treat with any of the recommended agents for GABS
• Agents such as a narrow-spectrum cephalosporin, Clindamycin or Amoxicillin/clavulanic acid, or the combination of Penicillin and Rifampin, are reasonable in the treatment of patients with GABS pharyngitis in whom initial Penicillin treatment has failed
• Consider intramuscular (IM) Benzathine Penicillin if noncompliance is suspected

For Multiple Episodes Over Months or Years

• It may be difficult to differentiate viral pharyngitis in a Streptococcus sp carrier from true group A streptococcal pharyngitis
• Assess for transmission within families wherein one family member or close contact may be an asymptomatic carrier of GABS
• It has been shown that vaccination against influenza and pneumococcus may result in significant reductions in the number of future episodes of acute sore throat
• Surgical removal of tonsils may be considered for patients whose symptomatic episodes do not diminish in frequency over time and for whom no alternative explanation for recurrent pharyngitis is evident
  • ≥7 episodes of tonsillitis over a 12-month period or ≥5 episodes/year in the past 2 years or ≥3 episodes/year in the past 3 years with documentation for each episode of sore throat and ≥1 of the following:
    • Temperature >38.3°C (101°F)
    • Cervical adenopathy
    • Tonsillar exudate
    • Positive test for GABS infection
  • Symptoms interfere with patient’s normal daily function