tonsillopharyngitis%20-%20acute
TONSILLOPHARYNGITIS - ACUTE
Patients with group A beta-hemolytic streptococcal pharyngitis have classic symptoms of tonsillar swelling/exudates, tender anterior cervical lymphadenopathy, with no cough but with fever of >38ºC.
Clinical features suggestive of a viral etiology are conjunctivitis, absence of fever, coryza, cough, diarrhea, anterior stomatitis, hoarseness, discrete ulcerative lesions, rhinorrhea and viral exanthem and/or enanthem.
Antibiotics will not be needed for every patient that presents with sore throat but it should not be withheld if the clinical condition is severe or group A beta-hemolytic streptococcus is suspected.

Follow Up

  • 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 group A beta-hemolytic streptococci 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 group A beta-hemolytic streptococci 
  • 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 group A beta-hemolytic streptococci  pharyngitis in whom initial Penicillin treatment has failed
  • Consider intramuscular 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 group A beta-hemolytic streptococci 
  • 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
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