Highlights & Basics
- Acute pharyngitis is characterized by acute onset of sore throat; the absence of cough, nasal congestion and discharge suggests a bacterial etiology.
- Rapid antigen detection tests allow immediate point-of-care assessment of group A Streptococcus (GAS) pharyngitis. However, nucleic acid amplification (via polymerase chain reaction) testing for GAS is becoming more common and is comparable to throat culture in sensitivity and specificity but is more rapid.
- The goal of treatment of GAS infection is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission.
- Acute pharyngitis is generally a self-limited condition with resolution within 2 weeks. Infected individuals are not immune to reinfection with most etiologic pathogens. Treatment typically involves supportive care (e.g., analgesics) and treatment of the causative pathogen (e.g. antibiotics for GAS infections).
- The only situation in which antibiotic prophylaxis to prevent GAS infections is recommended is for individuals with a history of rheumatic fever.
Quick Reference
History & Exam
Key Factors
child or adolescent age
winter or spring season (in bacterial pharyngitis)
summer/fall season (in enteroviral pharyngitis)
rhinorrhea, nasal congestion, and cough (in viral infection)
sore throat
pharyngeal exudate
cervical adenopathy
fever
headache
nausea, vomiting, and abdominal pain
conjunctivitis (in measles)
maculopapular rash (in measles)
Koplik spots (in measles)
scarlatiniform rash (in group A Streptococcus [GAS] pharyngitis)
Other Factors
sexual activity or abuse (in HIV, gonorrheal, or chlamydial infection)
treatment failure of penicillin
pharyngeal ulceration (in tularemia)
pharyngeal gray membrane (in diphtheria)
Diagnostics Tests
1st Tests to Order
rapid antigen test for group A Streptococcus (GAS)
nucleic acid amplification (via polymerase chain reaction) for group A Streptococcus (GAS)
Other Tests to consider
culture of throat swab for group A Streptococcus (GAS)
culture of throat swab for gonococcus or chlamydia
serum monospot for Epstein-Barr virus infection
Treatment Options
acute
all patients
all patients
without confirmed group A Streptococcus (GAS) or history of rheumatic fever
with confirmed group A Streptococcus (GAS) or history of rheumatic fever
with recurrent pharyngitis
with infectious mononucleosis
with Candida infection
with diphtheria
with tularemia
with gonococcus or chlamydia
Definition
Classifications
Clinical classification of pharyngitis
- Presence of fever, sore throat, pharyngeal exudate, cervical adenopathy, and lack of cough.
- Common viral causes include the Epstein-Barr virus (mononucleosis), adenoviruses, enteroviruses, influenza A and B, and parainfluenza
- May or may not have pharyngeal exudate
- Infectious mononucleosis is often accompanied by lymphadenopathy and splenomegaly[7]
- Diagnosis supported by a negative culture.
- Common in immunosuppressed individuals
- May accompany chemotherapy or irradiation for oropharyngeal cancer.
- Gray membrane in nose and throat that bleeds when dislodgedImage
- Rare outside low- and middle-income countries.
- Associated with conjunctivitis, rhinitis, cough, and characteristic exanthem (eruptive skin rash)
- Koplik spots (bluish-white, raised lesions on an erythematous base on the buccal mucosa) are pathognomonic.[8]
- Ulcerations and exudates in pharynx
- May develop gray membrane (mimicking diphtheria)[9]
- Unresponsive to penicillin therapy
- Associated with ingestion of raw or undercooked meat from nondomestic animals.European Centre for Disease Prevention and Control: factsheet on tularaemia
- Acute HIV
- Gonorrhea
- Chlamydia.
- Fever, sore throat, difficulty swallowing, neck pain/stiffness, vocal changes
- Diagnosis by CT
- Requires inpatient care.
Vignette
Common Vignette 1
Common Vignette 2
Other Presentations
Epidemiology
Etiology
Pathophysiology
Images
Diagnostic Approach
History
- Acute GAS pharyngitis is common in children and adolescents ages 5-15 years.[18] It is most frequent in the winter (or early spring) in temperate climates.[1] Enteroviral infection is most common in summer and fall.[1] [2] Diagnostic studies for GAS pharyngitis are not indicated for children <3 years old because acute rheumatic fever is rare in children <3 years old and the incidence of streptococcal pharyngitis is uncommon in this age group.[18] However, if they have a sibling with GAS infection then it may be worth considering for testing.[1]
- Tularemia is suggested by a history of ingestion of undercooked wild animal meat. History may also include a previous failure of response to a course of penicillin as treatment.[9]
- HIV, chlamydia, and gonorrhea should be considered as causative organisms in sexually active or abused individuals with pharyngitis, especially in those with negative cultures for GAS.[19]
- Immunocompromise may follow local tissue damage (e.g., irradiation for oropharyngeal cancer) or have a systemic cause (e.g., chemotherapy, post-transplant immunosuppression, HIV). Candida pharyngitis (e.g., thrush, an oral infection usually by Candida albicans) may be encountered in this clinical context. Culture for the suspected organism is diagnostic.
- Lack of immunization may be a finding in diphtheria or measles.
- Sore throat is a common symptom.
- Fever is common in pharyngitis and is a nonspecific symptom.
- Headache, nausea, vomiting, and abdominal pain may be present in children.[1]
- Rhinorrhea, nasal congestion, and cough are typically present in viral pharyngitis but absent in bacterial pharyngitis.
Physical exam
- Pharyngeal exudates
- Cervical adenopathy (painful anterior cervical adenopathy is common in GAS)
- Fever
- Lack of cough or rhinorrhea.
- Absence of cough (with the presence of cervical adenopathy) has the highest specificity for predicting streptococcal etiology.[25]
- Viral infections can be distinguished by the presence of rhinorrhea, nasal congestion, and cough.
- Gonococcal pharyngitis may be accompanied by anterior cervical adenopathy. Culture for the suspected organism is diagnostic.
- Diphtheria should be considered if a gray membrane is identified in the pharynx or nares. Culture for the suspected organism is diagnostic.Image
- Tularemia is suggested in the presence of ulcerations, exudates, and a history of ingestion of undercooked wild animal meat. Historical failure of response to penicillin therapy should also raise suspicion. Culture for the suspected organism is diagnostic.
- Koplik spots (bluish-white, raised lesions on an erythematous base on the buccal mucosa) are pathognomonic for measles.[8] A characteristic maculopapular rash or conjunctivitis may also be seen in measles.
Laboratory
- Positive test results in the absence of characteristic symptoms (fever, lack of cough, tonsillar exudates, and tender cervical adenopathy) likely represent colonization that is not clinically relevant; therefore, testing should be used only when the clinical symptoms are consistent with GAS disease.
- GAS rapid antigen detection tests allow immediate point-of-care assessment.
- A negative GAS rapid antigen test should be followed by conventional throat culture, especially in children, given their increased risk of rheumatic fever.
- Nucleic acid amplification (via polymerase chain reaction) testing for GAS is comparable to throat culture in sensitivity and specificity but is more rapid. In addition, PCR use in children with GAS in primary care led to more appropriate antibiotic use.[31] However, rapid in-office PCR is not widely available at the present time.[31] [32] [33] [34]
- Throat culture is particularly useful when rapid antigen tests are negative for GAS but the clinical syndrome is consistent with GAS. Rapid antigen tests will not detect other streptococci or Arcanobacterium hemolyticum that can be clinically indistinguishable from GAS pharyngitis.
- History of fever
- Lack of cough
- Tonsillar exudates
- Tender anterior cervical adenopathy.
- Tonsillar swelling or exudate (add 1 point)
- Tender anterior cervical adenopathy (add 1 point)
- No cough (add 1 point)
- Temperature > 38°C (add 1 point)
- Ages 3-14 years (add 1 point)
- Ages 15-44 years (no points)
- Ages ≥45 years (minus 1 point).
- Fever (during previous 24 hours)
- Purulence (pus on tonsils)
- Attend rapidly (within 3 days after onset of symptoms)
- Severely Inflamed tonsils
- No cough or coryza (inflammation of mucus membranes in the nose).
Radiology
Risk Factors
History & Exam
Tests
Differential Diagnosis
Epiglottitis
Differentiating Signs/Symptoms
- Severe and acute onset of sore throat and fever.
- Notable change in the quality of the voice to a muffled texture.
- Drooling of saliva from the mouth.
- Tripod or sniffing posture in children.
Differentiating Tests
- Direct visualization of the epiglottis (under controlled circumstances in the operating room, with the immediate capability of intubation should the airway close), or lateral neck x-rays.Image
Retropharyngeal, peritonsillar, and lateral abscess
Differentiating Signs/Symptoms
- Sore throat, fever, neck pain, muffled voice.
- Most common in children ages 2-4 years.
- May be associated with history of oral or pharyngeal trauma in older children.
Differentiating Tests
- Imaging studies of the neck may be required to visualize the abscess.
Infectious mononucleosis
Differentiating Signs/Symptoms
- Pharyngitis of longer than several days' duration.
- Adenopathy, splenomegaly.
Differentiating Tests
- Serum monospot positive for Epstein-Barr virus infection.
- Atypical lymphocytes in peripheral blood.
Diphtheria
Differentiating Signs/Symptoms
- Pharyngitis with gray membrane adherent to the pharynx.Image
- Rarely seen except in low- and middle-income countries or unvaccinated populations.
Differentiating Tests
- Culture recovery of organism.
Differentiating Signs/Symptoms
- Thrombophlebitis of the jugular vein, with a mixed anaerobic abscess.
- Typically present in patients with systemic inflammatory response syndrome (SIRS) or sepsis.
Differentiating Tests
- Imaging studies of the neck demonstrate abscess.
Measles
Differentiating Signs/Symptoms
- Systemic infection with conjunctivitis, rhinorrhea, cough, and characteristic exanthema (maculopapular rash).
- Pharyngitis appears during the exanthematous phase.
- Koplik spots (bluish-white, raised lesions on an erythematous base on the buccal mucosa) are pathognomonic.
Differentiating Tests
- Antimeasles IgM, viral culture, or polymerase chain reaction: positive.
Coronavirus disease 2019 (COVID-19)
Differentiating Signs/Symptoms
- Close contact with a confirmed or probable case of COVID-19, in the 14 days prior to symptom onset.
- May have other symptoms including cough, gastrointestinal symptoms, or systemic symptoms including fever.
- However, patients may present with mild symptoms or sore throat in isolation.
- The situation is evolving rapidly; see our COVID-19 topic for further information.
Differentiating Tests
- Real-time reverse transcription polymerase chain reaction (RT-PCR): positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA.
Behcet syndrome
Differentiating Signs/Symptoms
- Vesicles on the pharynx, genital ulcers, skin lesions, eye lesions.
Differentiating Tests
- Laboratory testing and imaging are not useful in making the diagnosis of Behcet syndrome, but do play a role in ruling out alternative diagnoses.
Stevens-Johnson syndrome
Differentiating Signs/Symptoms
- Preceding drug history of anticonvulsant use, recent infections, seizures, or new medications.
- Vesicles on the pharynx along with more pronounced mucosal changes.
Differentiating Tests
- Diagnosis is made by clinical presentation and confirmed with skin biopsy.
Kawasaki disease
Differentiating Signs/Symptoms
- Typical signs include fever longer than 5 days, polymorphic rash, injected eyes (conjunctivitis), and mucosal erythema with strawberry tongue.
- Diffuse inflammation of oral mucosa.
Differentiating Tests
- Diagnosis is made by clinical presentation.
- Coronary artery aneurysms may be present on echocardiography.
Hand-foot-and-mouth disease
Differentiating Signs/Symptoms
- Common childhood viral infection caused most often by coxsackievirus A16.
- Usually a mild illness characterized by low-grade fever, painful oral ulcers, and vesicles on the palms of the hands and soles of the feet.
Differentiating Tests
- Elevated WBC count, atypical lymphocytes.
- Polymerase chain reaction molecular assay is an emerging diagnostic modality.
Oropharyngeal cancer
Differentiating Signs/Symptoms
- Hoarseness, dysphonia, sore throat, difficulty swallowing, vocal cord lesions on indirect laryngoscopy, and neck mass or adenopathy.
Differentiating Tests
- CT of the neck may be diagnostic and is essential to evaluate the extent of disease.
- Cytologic analysis of fine needle aspirate may establish the diagnosis, although biopsy is usually required.
Aphthous ulcers
Differentiating Signs/Symptoms
- Multiple, recurrent small, erythematous, round or ovoid ulcers with circumscribed margins, typically presenting first in childhood or adolescence.
Differentiating Tests
- Diagnosis is based on the history and clinical examination, with exclusion of a systemic etiology; there are no specific laboratory findings.
Criteria
Screening
Treatment Approach
With group A Streptococcus (GAS) pharyngitis
With infectious mononucleosis
With Candida infection
With diphtheria
With tularemia
With gonococcus or chlamydia
Treatment Options
all patients
supportive care
Primary Options
- acetaminophen
children: 10-15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 325-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day
- acetaminophen
- ibuprofen
children: >6 months of age: 10 mg/kg orally every 6-8 hours when required, maximum 40 mg/kg/day; adults: 200-400 mg orally every 4-6 hours when required, maximum 2400 mg/day
- ibuprofen
Secondary Options
- lidocaine oronasopharyngeal solution
(2%) children and adults: consult product literature for dose information
- lidocaine oronasopharyngeal solution
Comments
- Analgesics and local anesthetics can be used for symptoms of sore throat, headache, and fever, although aspirin should be avoided in children because of its association with Reye syndrome. Salt water gargling is not proven to be efficacious, but it also does no harm.[46] Anesthetic sprays may provide temporary relief from the pain of pharyngitis, although one randomized, placebo-controlled trial demonstrated no benefit symptomatically from viscous lidocaine.[50]
- There are no current recommendations for the use of corticosteroids in the symptomatic treatment of acute pharyngitis.[1] [64] One Cochrane systematic review reports that there is an increased likelihood of complete resolution of pain at 24 hours by 2.40 times when they are given in combination with antibiotic therapy. However, the review cited lack of studies with adverse event reporting and lack of pediatric studies as a reason for caution in using corticosteroids, given the minimal clinical benefit.[59] Infectious Diseases Society of America guidelines do not currently recommend this treatment.[1]
without confirmed group A Streptococcus (GAS) or history of rheumatic fever
delayed or no antibiotic therapy
Comments
- In instances when the rapid test for GAS proves negative, a reasonable approach is no antibiotics at all, with a next day follow-up if the throat culture is positive. A throat culture should be conducted in all patients with a negative rapid antigen test for GAS but who have symptoms consistent with GAS pharyngitis. Antibiotics for streptococcal pharyngitis decrease symptom duration by less than 1 day but prevent rheumatic fever and rheumatic heart disease.[73]
with confirmed group A Streptococcus (GAS) or history of rheumatic fever
antibiotic therapy
Primary Options
penicillin V potassium
children ≤27 kg: 250 mg orally two to three times daily for 10 days; children >27 kg and adults: 500 mg orally two to three times daily for 10 days
penicillin G benzathine
children ≤27 kg: 600,000 units intramuscularly as a single dose; children >27 kg and adults: 1.2 million units intramuscularly as a single dose
- amoxicillin
children: 50 mg/kg/day orally given in 2 divided doses for 10 days, maximum 1000 mg/day; adults: 500 mg orally twice daily for 10 days
- amoxicillin
Secondary Options
- azithromycin
children: 12 mg/kg (maximum 500 mg/dose) orally once daily on day 1, followed by 6 mg/kg (maximum 250 mg/dose) once daily for 4 days; adults: 500 mg orally once daily on day 1, followed by 250 mg once daily for 4 days
- azithromycin
- clarithromycin
children: 15 mg/kg/day orally given in divided doses every 12 hours for 10 days, maximum 500 mg/day; adults: 250 mg orally twice daily for 10 days
- clarithromycin
- erythromycin base
children: 25-50 mg/kg/day orally given in 4 divided doses for 10 days, maximum 2000 mg/day; adults: 250-500 mg orally four times daily for 10 days
- erythromycin base
- cephalexin
children: 25-50 mg/kg/day orally given in divided doses every 12 hours for 10 days, maximum 1000 mg/day; adults: 500 mg orally twice daily for 10 days
- cephalexin
- cefadroxil
children: 30 mg/kg/day orally given in 1-2 divided doses for 10 days, maximum 1000 mg/day; adults: 1000 mg/day orally given in 1-2 divided doses for 10 days
- cefadroxil
- clindamycin
children: 20 mg/kg/day orally given in divided doses every 8 hours for 10 days, maximum 1800 mg/day; adults: 300-600 mg orally every 8 hours for 10 days
- clindamycin
Comments
- Antibiotic treatment should be reserved for patients with microbiologically confirmed (e.g., GAS) pharyngitis (a positive rapid antigen test, nucleic acid amplification (via polymerase chain reaction) test, or culture) and should not be based on a clinical diagnosis alone.[58] If pharyngitis symptoms have not improved after 3 or 4 days of appropriate antibiotic therapy, alternate diagnoses should be considered.
- The goal of treatment for GAS is to prevent acute rheumatic fever and rheumatic heart disease, reduce the severity and duration of symptoms, and prevent transmission.[1]
- There is no beta-lactam resistance inherent with GAS, so treatment may be carried out with penicillin or amoxicillin, except in the case of a penicillin allergy where a macrolide, cephalosporin, or clindamycin may be used with caution.[1] [74] [75] GAS resistance to macrolides and clindamycin (inducible resistance) has been reported in children.[76] [77] Doxycycline and trimethoprim/sulfamethoxazole are not recommended for the treatment of GAS pharyngitis.[1]
- Oral penicillin V (also known as phenoxymethylpenicillin) is the treatment of choice, given for 10 days' duration. For patients who are unable to complete a 10-day oral course, a single intramuscular dose of penicillin G benzathine can be given. Oral amoxicillin may be substituted in children, as its taste is more palatable than that of penicillin V. Avoid amoxicillin when treating GAS with concomitant infectious mononucleosis, because of the possibility of an amoxicillin rash.[1] [91]
- Despite guideline recommendations, there is evidence that a shorter course (i.e., 3-6 days) of oral penicillin is as effective as a 10-day course in treating acute pharyngitis, without evidence of an increased risk of poststreptococcal glomerulonephritis or rheumatic fever.[78] One study found that a 3-day course of azithromycin or a 5-day course of cefaclor resulted in equivalent symptomatic and bacteriologic cure compared with a 10-day course of amoxicillin.[79] However, incidence rates of rheumatic fever or rheumatic heart disease were not assessed in this study.[79] Another study found penicillin V for 5 days was noninferior in clinical outcome to penicillin V for 10 days (at different doses) although, again, effect on the incidence rates of rheumatic fever or rheumatic heart disease were not assessed.[80] As the evidence is still emerging, shorter courses of antibiotics should still be considered an emerging alternative, rather than the recommended, primary option.
- Antibiotic prophylaxis in individuals with a history of rheumatic fever is recommended to decrease the risk of recurrence of rheumatic fever.
with recurrent pharyngitis
with infectious mononucleosis
hydration, rest ± corticosteroid ± intravenous immune globulin
Comments
- The goal of treatment is supportive care, including good hydration.
- Rest remains a frequent recommendation, but its true usefulness is unknown. Avoidance of strenuous physical activity (including contact sports) in the initial 3 to 4 weeks of illness is desirable in light of the potential for splenic rupture, although cases have been demonstrated up to 8 weeks from initial diagnosis. An abdominal ultrasound is recommended to confirm resolution of splenomegaly prior to clearance for strenuous physical activity.[81]
- Patients with severe systemic symptoms of infectious mononucleosis and its complications should be admitted to hospital.
- Systemic corticosteroids should be reserved for patients with severe airway obstruction, severe thrombocytopenia, or hemolytic anemia.[82]
- Intravenous immune globulin, which modulates the immune system response, may be used in patients with immune thrombocytopenia.
- See Infectious mononucleosis .
with Candida infection
antifungal therapy
Comments
- Candida albicans is usually susceptible to topical therapy.
- Mild to moderate cases of oral candidiasis may be treated with polyene antifungal agents (e.g., nystatin). It should be noted that nystatin suspension has a high sucrose content and its frequent use, especially in a xerostomic patient, may increase the risk of dental caries.
- For people with fungal infection that is more widespread, involving more of the surfaces of the mouth, or in those with a longer duration of symptoms, an azole antifungal such as fluconazole is more appropriate.
- See Oral candidiasis .
with diphtheria
diphtheria antitoxin plus antibiotic therapy
Comments
- Diphtheria antitoxin is the mainstay of therapy and should be administered promptly, as soon as there is a strong clinical suspicion of diphtheria. Laboratory confirmation of the diagnosis should not delay administration of antitoxin, as patients can deteriorate quickly. Antitoxin can only neutralize free toxin in the serum, and the efficacy decreases significantly after the onset of mucocutaneous symptoms, which signals the movement of toxin into the cells.
- Antibiotics are not a substitute for treatment with antitoxin, but serve to prevent further production of toxin by eradicating the Corynebacterium diphtheriae organism. They also treat localized cutaneous infections. In addition, antibiotics prevent transmission of the disease to contacts. C diphtheriae is usually susceptible to penicillin and erythromycin.[84]
- See Diphtheria .
with tularemia
antibiotic therapy
Comments
- Antibiotic treatment with agents active against Francisella tularensis is the mainstay of therapy in all patients, regardless of the clinical manifestation.
- Standard isolation practices should be followed, and the clinical laboratory should be alerted to tularemia as a suspected diagnosis prior to clinical specimens being sent.
- See Tularemia .
with gonococcus or chlamydia
antibiotic therapy
Comments
- Gonococcus is harder to eradicate from the pharynx than from urogenital sites. For uncomplicated gonococcal infection of the pharynx, intramuscular ceftriaxone as a single dose is recommended. If chlamydia coinfection is identified, chlamydia should be treated with oral doxycycline, or azithromycin during pregnancy. A test of cure should be ordered to ensure eradication following treatment.[87]
- See Gonorrhea infection (which also covers chlamydia coinfection).
Prevention
Primary Prevention
Secondary Prevention
Follow-Up Overview
Prognosis
Monitoring
Complications
Citations
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Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013 Nov 5;(11):CD000023.[Abstract][Full Text]
van Driel ML, De Sutter AI, Thorning S, et al. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2021 Mar 17;3:CD004406.[Abstract][Full Text]
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Key Articles
Other Online Resources
Referenced Articles
Guidelines
Diagnostic
Summary
Diagnosis is based on symptoms.Laboratory tests are not usually required; however, specific antibody tests may be needed to identify the cause of illness in people who do not have a typical case of infectious mononucleosis.Published by
National Center for Infectious Diseases; Centers for Disease Control and Prevention
Published
2020
Summary
Discusses the indications for tonsillectomy in children and guidance on when watchful waiting is appropriate.Published by
American Academy of Otolaryngology-Head and Neck Surgery Foundation
Published
2019
Summary
Information page for healthcare professionals. Discusses the etiology, clinical features, diagnosis and treatment options, prognosis and complications, and prevention of acute pharyngitis caused by group A Streptococcus(GAS).Published by
Centers for Disease Control and Prevention
Published
2022
Summary
Discusses the principles behind the diagnosis and treatment of GAS pharyngitis in otherwise healthy adults and the use of clinical screening for GAS pharyngitis, which can substantially reduce unnecessary use of antibiotics.Published by
Centers for Disease Control and Prevention
Published
2017
Summary
These guidelines cover the following upper-respiratory conditions: viral upper respiratory tract infections, acute pharyngitis, noninfectious rhinitis, and acute sinusitis. In 2017, the guidelines underwent major revisions, especially regarding GAS pharyngitis testing and treatment recommendations, and acute sinusitis treatment recommendations.Published by
Institute for Clinical Systems Improvement
Published
2017
Summary
Discusses the primary prevention of acute rheumatic fever, which is accomplished by proper identification and adequate antibiotic treatment of GAS tonsillopharyngitis. Diagnosis of GAS pharyngitis is best accomplished by combining clinical judgment with diagnostic test results, the criterion standard of which is the throat culture.Published by
American Heart Association
Published
2009
Summary
Provides current evidence-based prevention, diagnostic and treatment recommendations for gonococcal infections.Published by
Centers for Disease Control and Prevention
Published
2021
Summary
Provides a practical guide to aid the diagnosis and treatment of group A streptococcal (GAS) pharyngitis.Published by
Canadian Paediatric Society
Published
2021
Treatment
Summary
Discusses the indications for tonsillectomy in children and guidance on when watchful waiting is appropriate.Published by
American Academy of Otolaryngology-Head and Neck Surgery Foundation
Published
2019
Summary
Information page for healthcare professionals. Discusses the etiology, clinical features, diagnosis and treatment options, prognosis and complications, and prevention of acute pharyngitis caused by group A Streptococcus (GAS).Published by
Centers for Disease Control and Prevention
Published
2022
Summary
Penicillin is recommended as the initial treatment of group A streptococcal pharyngitis, with erythromycin for penicillin-allergic patients. Broad-spectrum macrolides and fluoroquinolones are not appropriate for uncomplicated infections. Also provides guidance to physicians to improve patient satisfaction when antibiotics are not needed.Published by
Centers for Disease Control and Prevention
Published
2017
Summary
These guidelines cover the following upper-respiratory conditions: viral upper respiratory tract infections, acute pharyngitis, noninfectious rhinitis, and acute sinusitis. In 2017, the guidelines underwent major revisions, especially regarding GAS pharyngitis testing and treatment recommendations, and acute sinusitis treatment recommendations.Published by
Institute for Clinical Systems Improvement
Published
2017
Summary
Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected. Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for GAS. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis. Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39°C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening). Clinicians should not prescribe antibiotics for patients with the common cold.Published by
American College of Physicians
Published
2016
Summary
Initial episodes of oropharyngeal candidiasis can be treated with clotrimazole troches or nystatin suspension or pastilles.Oral fluconazole is at least as effective and may be superior to topical therapy.Published by
Infectious Diseases Society of America
Published
2016
Summary
Discusses the primary prevention of acute rheumatic fever, which is accomplished by proper identification and adequate antibiotic treatment of GAS tonsillopharyngitis. Penicillin (either oral penicillin VK [also known as phenoxymethylpenicillin] or injectable benzathine penicillin) is the treatment of choice, or, for penicillin-allergic patients, a narrow-spectrum oral cephalosporin, oral clindamycin, or various oral macrolides or azalides. Patients who have had an attack of rheumatic fever are at very high risk of developing recurrences after subsequent GAS pharyngitis and need continuous antimicrobial prophylaxis to prevent such recurrences (secondary prevention).Published by
American Heart Association
Published
2009
Summary
CDC's Sexually Transmitted Infections (STI) Treatment Guidelines, 2021 provides current evidence-based prevention, diagnostic and treatment recommendations for gonococcal infections.Published by
Centers for Disease Control and Prevention
Published
2021
Summary
Provides a practical guide to aid the diagnosis and treatment of group A streptococcal (GAS) pharyngitis.Published by
Canadian Paediatric Society
Published
2021