Pharyngitis [2013 Update]

Description: Pharyngitis is a common presenting complaint in primary care. While viruses are the most common cause, group A beta hemolytic Streptococcus infection (GABHS), ABHS can be the cause in children (15%–30%) and adults (5%–10%). The primary reason to identify and treat GABHS is to decrease the risk of acute rheumatic fever. A growing concern is the indiscriminate use of antibiotics, which may increase the incidence of allergic reactions to antiobitics and the emergence of resistant strains of pathogenic bacteria.

This CME activity helps clinicians estimate the probability of GABHS based on the symptoms of the patient. The probability is used to identify a cost effective strategy for diagnosing and treating GABHS for that patient.

Some of the key aspects of care are:

• Reduce the indiscriminate use of antibiotics for those who will not benefit – most sore throats are viral.
• Test for strep only in patients with suggestive signs and symptoms (e.g., severe sore throat, fever, tender anterior cervical lymphadenopathy, red pharynix with tonsillar swelling, no cough).
• If a rapid strep screen is negative:
  • In patients ≥ 16 years of age, NOT sending a confirming throat culture is acceptable.
  • In patients < 16 years of age, a confirming throat culture should be sent.
• Recommended medications and their costs have been updated:
  • Amoxicillin as a single daily dose for 10 days is as effective as pennicillin V or amoxicillin given multiple times per day for 10 days.
  • A table lists options for treating patients with symptomatic, recurrent GABHS pharyngitis.

New information in this updated activity includes:

• The national performance measure is now in the text: for children 2–18 years old with a diagnosis of pharyngitis and a prescription for antibiotics, the percentage who had a strep test (screen and/or culture).
• Amoxicillin dosing is now 50 mg/kg (1 gram maximum) once daily.
• If allergic to penicillin, a 10-day course of first generation cephalosporin is indicated if no history of an immediate or type I hypersensivity to penicillin. Oral clindamycin is an acceptable alternative if one is unable to use a first generation cephalosporin.