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| [[Sore throat resident survival guide (pediatrics)|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align=center| {{fontcolor|#2B3B44|Sore throat resident survival guide (pediatrics) Microchapters}}
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Sore throat resident survival guide (pediatrics) Microchapters}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Sore throat resident survival guide (pediatrics)#Overview|Overview]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sore throat resident survival guide (pediatrics)#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Sore throat resident survival guide (pediatrics)#Causes|Causes]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sore throat resident survival guide (pediatrics)#Causes|Causes]]
|-
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Sore throat resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sore throat resident survival guide (pediatrics)#FIRE: Focused Initial Rapid Evaluation|FIRE]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Sore throat resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sore throat resident survival guide (pediatrics)#Complete Diagnostic Approach|Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Sore throat resident survival guide (pediatrics)#Treatment|Treatment]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sore throat resident survival guide (pediatrics)#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Sore throat resident survival guide (pediatrics)#Do's|Do's]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sore throat resident survival guide (pediatrics)#Do's|Do's]]
|-
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Sore throat resident survival guide (pediatrics)#Don'ts|Don'ts]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sore throat resident survival guide (pediatrics)#Don'ts|Don'ts]]
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|}


==Overview==
==Overview==
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Sore throat is an acute upper respiratory tract infection that affects the respiratory mucosa of the throat.


==Causes==
==Causes==
if left untreated cause acute rheumatic fever (ARF), According to WHO, at least 15.6 million people have rheumatic heart disease (RHD), and 233 000 deaths annually are directly attributable to ARF. Due to the limitations of reports related to limited resources in developing countries, it is likely that the prevalence and incidence of ARF are largely underestimated.
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
* [[Life threatening cause 1]]
* [[Life threatening cause 2]]
* [[Life threatening cause 3]]


*[[Croup]]
*Acute [[epiglottitis]]
{| class="wikitable"
|+Differentiating [[croup]] and [[epiglottitis]]<ref name="pmid21091577">{{cite journal| author=Tibballs J, Watson T| title=Symptoms and signs differentiating croup and epiglottitis. | journal=J Paediatr Child Health | year= 2011 | volume= 47 | issue= 3 | pages= 77-82 | pmid=21091577 | doi=10.1111/j.1440-1754.2010.01892.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21091577  }}</ref><ref name="pmid11464324">{{cite journal| author=Stroud RH, Friedman NR| title=An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. | journal=Am J Otolaryngol | year= 2001 | volume= 22 | issue= 4 | pages= 268-75 | pmid=11464324 | doi=10.1053/ajot.2001.24825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11464324  }}</ref>
!
![[Croup]]
![[Epiglottitis]]
|-
|Clinical features
|Acute [[stridor]] with [[coughing]] and lack of [[drooling]]
|Acute [[stridor]] with [[drooling]] and lack of [[coughing]]
|-
|Course
|Slow-developing airway obstruction - rare severe obstruction
|Rapidly courses with complete airway obstruction and [[shock]]
|-
|Imaging
|Steeple sign in an anterior-posterior [[neck]] [[x-ray]]
|Thumb sign in a lateral [[neck]] [[x-ray]]
|-
|Additional clinical features
(less reliable for diagnostic)
|Sore throat
*Barking cough
|Sore throat
*Sitting position
*Refusal of food or drink
*Inability to swallow
*[[Vomiting]]
|-
|Treatment
|[[Nebulization]] of [[racemic]] [[epinephrine]]:
*Preferred regimen: 0.5 mL of a 2.25% [[racemic]] [[epinephrine]] solution diluted in 3 mL of normal [[saline]]
|Medical emergency:
*Invasive airway management (oral [[intubation]] or [[tracheotomy]])
*[[Antibiotics]]
*[[Intensive care unit]]
|}
===Common Causes===
===Common Causes===


=== [[Common cause 1|Bacteria]] ===
===[[Common cause 1|Bacteria]]===
 
*''Streptococcus( group A beta-haemolytic ) most commonly <ref name="pmid245893142" />''
*''Haemophilus influenzae''
*''Moraxella catarrhalis''
 
===viruses<ref name="pmid24589314" />===
 
*Rhinovirus
*coronavirus.
*respiratory syncytial virus.
*metapneumovirus.
*Epstein–Barr virus.


* ''Streptococcus( group A beta-haemolytic )''
===chemical irritation<ref name="pmid24589314" />===
* ''Haemophilus influenzae''
* ''Moraxella catarrhalis''


*[[Common cause 2]]
*nasogastric tubes.
*[[Common cause 3]]
*smoke.
*[[Common cause 4]]
*[[Common cause 5]]


==FIRE: Focused Initial Rapid Evaluation==
==FIRE: Focused Initial Rapid Evaluation==
<br />
<nowiki>=== Table 1===</nowiki>
Clinical signs and symptoms of GABSH pharingitis , their sensitivity and specificity
{| class="wikitable"
! colspan="1" rowspan="1" |Symptoms and Clinical Findings
|-
| colspan="1" rowspan="1" |'''Absence of cough'''
|-
| rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Anterior cervical nodes swollen or enlarged'''
|-
| rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Headache'''
|-
| rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Myalgia'''
|-
| rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Palatine petechiae'''
|-
| rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Pharyngeal exudates'''
|-
| rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Fever >38°C'''
|-
| rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Tonsillar exudate'''
|}
=== Table 2===[3]<ref name="pmid21281502">{{cite journal| author=Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M| title=Update on the management of acute pharyngitis in children. | journal=Ital J Pediatr | year= 2011 | volume= 37 | issue=  | pages= 10 | pmid=21281502 | doi=10.1186/1824-7288-37-10 | pmc=3042010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21281502  }} </ref>
Clinical Score for GABSH pharyngitis.
{| class="wikitable"
! colspan="1" rowspan="1" |
! colspan="1" rowspan="1" |Clinical signs and symptoms
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Recent exposure to GABHS, pharyngeal exudate, enlarged or tender cervical nodes, fever
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Season, age, white cells count, fever, absence of cough, enlarged cervical nodes, tonsillar exudate or swelling
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Swollen and tender anterior cervical nodes, tonsillar exudate
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Fever, cervical nodes enlargement, tonsillar exudate or swelling or hypertrophy, Absence of cough
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Season, age, fever, enlarged cervical nodes, tonsillar exudate or swelling or hypertrophy, absence of cough or rhinitis or conjunctivitis
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Tonsillar hypertrophy, enlarged cervical nodes, absence of rhinitis, scarlet fever rash
|}
=== Table 3 ===[3]<ref name="pmid21281502">{{cite journal| author=Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M| title=Update on the management of acute pharyngitis in children. | journal=Ital J Pediatr | year= 2011 | volume= 37 | issue=  | pages= 10 | pmid=21281502 | doi=10.1186/1824-7288-37-10 | pmc=3042010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21281502  }} </ref>
Centor Score,
{| class="wikitable"
! colspan="1" rowspan="1" |Clinical criteria
! colspan="1" rowspan="1" |Points
|-
| colspan="1" rowspan="1" |Absence of cough
| colspan="1" rowspan="1" |1
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |Swollen and tender anterior cervical nodes
| colspan="1" rowspan="1" |1
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |Temperature > 38°C
| colspan="1" rowspan="1" |1
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |Tonsillar exudate or swelling
| colspan="1" rowspan="1" |1
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |Age 3 to 14 years
| colspan="1" rowspan="1" |1
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |Age 15 to 44 years
| colspan="1" rowspan="1" |0
|-
| colspan="2" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |Age 45 years and older
| colspan="1" rowspan="1" | -1
|}
<br />
==Complete Diagnostic Approach{{cite web|url=https://portal.nnpbc.com/pdfs/education/dst/remote-practice/DST-REM-Pharyngitis-Pediatric-[01-Jun-18-Present].pdf|title=portal.nnpbc.com|format=|work=|accessdate=}}==
• Rapid strep test (if available)
• Throat swab for culture and sensitivity


==Complete Diagnostic Approach==
• If the child is greater than 2 years old, culture the throat before treatment or do rapid Strep antigen test (if available); if negative, do throat culture.
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | A01 | | | A01= }}
{{familytree | | | | |!| | | | }}
{{familytree | | | | B01 | | | B01= }}
{{familytree | | |,|-|^|-|.| | }}
{{familytree | | C01 | | C02 | C01= | C02= }}


{{familytree/end}}
• Monospot if suspect vira


==Treatment==
==Treatment <ref name"pmid21281502"="">{{cite journal| author=Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M| title=Update on the management of acute pharyngitis in children. | journal=Ital J Pediatr | year= 2011 | volume= 37 | issue=  | pages= 10 | pmid=21281502 | doi=10.1186/1824-7288-37-10 | pmc=3042010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21281502  }} </ref>==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
A sore throat caused by a viral infection usually lasts five to seven days and doesn't require medical treatment{{cite web |url=https://portal.nnpbc.com/pdfs/education/dst/remote-practice/DST-REM-Pharyngitis-Pediatric-[01-Jun-18-Present].pdf |title=portal.nnpbc.com |format= |work= |accessdate=}}.
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01= }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01= }}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
{{familytree/end}}


==Do's==
To ease pain and fever, many people turn to acetaminophen  may be given every four to six hours as needed but should not be given more than five times in a 24-hour period.,) or other mild pain relievers..
* The content in this section is in bullet points.


==Don'ts==
if  bacterial infection first choice treatment is penicillin ,  since GABHS remains universally susceptible to penicillin. Although penicillin V is the drug of choice, ampicillin or amoxicillin are good taste, represent a suitable option in children.
* The content in this section is in bullet points.
 
<br />
 
=== Table 4===<ref name="pmid21281502">{{cite journal| author=Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M| title=Update on the management of acute pharyngitis in children. | journal=Ital J Pediatr | year= 2011 | volume= 37 | issue=  | pages= 10 | pmid=21281502 | doi=10.1186/1824-7288-37-10 | pmc=3042010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21281502  }} </ref>
Therapeutic options for GABHS pharyngitis recommended by American Hearth Association and American Academy of Pediatrics AAP [13,4].
{| class="wikitable"
! colspan="1" rowspan="1" |Drug
! colspan="1" rowspan="1" |Dose
! colspan="1" rowspan="1" |Duration
|-
| colspan="1" rowspan="1" |'''Penicillins'''
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Penicillin V (oral)'''
| colspan="1" rowspan="1" |• Children <27 kg: 400 000 U (250 mg) 2 to 3 times daily ;
• Children >27 kg, adolescents, and adults: 800 000 (500 mg) 2 to 3 times daily
| colspan="1" rowspan="1" |10 days
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Amoxicillin (oral)'''
| colspan="1" rowspan="1" |50 mg/kg once daily (maximum 1 g)
| colspan="1" rowspan="1" |10 days
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Benzathin Penicillin G (intramuscular)'''
| colspan="1" rowspan="1" |• Children <27 kg: 600 000 U (375 mg);
• Children >27 kg, adolescents, and adults:
1 200 000 U (750 mg)
| colspan="1" rowspan="1" |Once
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="3" rowspan="1" |'''For individuals allergic to penicillin'''
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Narrow-spectrum cephalosporin (cephalexin, cefadroxil) (oral)*'''
| colspan="1" rowspan="1" |Variable
| colspan="1" rowspan="1" |10 days
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Clindamycin (oral)'''
| colspan="1" rowspan="1" |20 mg/kg per day divided in 3 doses (maximum 1.8 g/d)
| colspan="1" rowspan="1" |10 days
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Azithromycin (oral)'''
| colspan="1" rowspan="1" |12 mg/kg once daily (maximum 500 mg)
| colspan="1" rowspan="1" |5 days
|-
| colspan="3" rowspan="1" |
----
|-
| colspan="1" rowspan="1" |'''Clarithromycin (oral)'''
| colspan="1" rowspan="1" |15 mg/kg per day divided BID (maximum 250 mg BID)
| colspan="1" rowspan="1" |10 days
|}
'''*''' Patients with immediate or type I hypersensitivity to penicillin should not be treated with a cephalosporin [4].
 
==Do's<ref name="urlUpToDate3">{{cite web |url=https://www.uptodate.com/contents/sore-throat-in-children-beyond-the-basics |title=UpToDate |format= |work= |accessdate=}}</ref>==
 
*'''Pain reliever''' :Throat pain can be treated with a mild pain reliever such as acetaminophen ( Tylenol) or a nonsteroidal anti-inflammatory agent such as ibuprofen ( Advil, Motrin)
*'''keep hydration:'''Drinking alot  of fluid To reduce the risk of dehydration, parents can offer warm or cold liquids.
*'''Other intervention:''' include sipping warm beverages (eg, honey or lemon tea, chicken soup), cold beverages, or eating cold or frozen desserts (eg, ice cream, popsicles). These treatments are safe for children
 
==Don'ts<ref name="urlUpToDate4">{{cite web |url=https://www.uptodate.com/contents/sore-throat-in-children-beyond-the-basics |title=UpToDate |format= |work= |accessdate=}}</ref>==
 
*Aspirin is not recommended for children <18 years due to the risk of a potentially serious condition known as Reye syndrome.
*Sprays containing topical anesthetics are available to treat sore throat  We do not recommend throat sprays for children.
*medicated throat lozenges are available to relieve dryness or pain it is not clear that lozenges work any better than hard candy. We do not recommend throat lozenges for children, especially children younger than five years, who can choke. Sucking on hard candy may provide some relief for children older than five years, who are not at risk for choking
*Honey should not be given to children younger than 12 months due to the potential risk of botulism poisoning.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
https://www.wikidoc.org/index.php/Sore_throat_resident_survival_guide_(pediatrics)#cite_note-pmid21281502-3


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Latest revision as of 21:45, 1 March 2021



Resident
Survival
Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Asia Alriashi, MD[2]

Synonyms and keywords:

Sore throat resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Sore throat is an acute upper respiratory tract infection that affects the respiratory mucosa of the throat.

Causes

if left untreated cause acute rheumatic fever (ARF), According to WHO, at least 15.6 million people have rheumatic heart disease (RHD), and 233 000 deaths annually are directly attributable to ARF. Due to the limitations of reports related to limited resources in developing countries, it is likely that the prevalence and incidence of ARF are largely underestimated.

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Differentiating croup and epiglottitis[1][2]
Croup Epiglottitis
Clinical features Acute stridor with coughing and lack of drooling Acute stridor with drooling and lack of coughing
Course Slow-developing airway obstruction - rare severe obstruction Rapidly courses with complete airway obstruction and shock
Imaging Steeple sign in an anterior-posterior neck x-ray Thumb sign in a lateral neck x-ray
Additional clinical features

(less reliable for diagnostic)

Sore throat
  • Barking cough
Sore throat
  • Sitting position
  • Refusal of food or drink
  • Inability to swallow
Treatment Nebulization of racemic epinephrine: Medical emergency:

Common Causes

Bacteria

  • Streptococcus( group A beta-haemolytic ) most commonly [3]
  • Haemophilus influenzae
  • Moraxella catarrhalis

viruses[4]

  • Rhinovirus
  • coronavirus.
  • respiratory syncytial virus.
  • metapneumovirus.
  • Epstein–Barr virus.

chemical irritation[4]

  • nasogastric tubes.
  • smoke.

FIRE: Focused Initial Rapid Evaluation


=== Table 1=== Clinical signs and symptoms of GABSH pharingitis , their sensitivity and specificity

Symptoms and Clinical Findings
Absence of cough

Anterior cervical nodes swollen or enlarged

Headache

Myalgia

Palatine petechiae

Pharyngeal exudates

Fever >38°C

Tonsillar exudate


=== Table 2===[3][5] Clinical Score for GABSH pharyngitis.

Clinical signs and symptoms
Recent exposure to GABHS, pharyngeal exudate, enlarged or tender cervical nodes, fever

Season, age, white cells count, fever, absence of cough, enlarged cervical nodes, tonsillar exudate or swelling

Swollen and tender anterior cervical nodes, tonsillar exudate

Fever, cervical nodes enlargement, tonsillar exudate or swelling or hypertrophy, Absence of cough

Season, age, fever, enlarged cervical nodes, tonsillar exudate or swelling or hypertrophy, absence of cough or rhinitis or conjunctivitis

Tonsillar hypertrophy, enlarged cervical nodes, absence of rhinitis, scarlet fever rash

=== Table 3 ===[3][5] Centor Score,

Clinical criteria Points
Absence of cough 1

Swollen and tender anterior cervical nodes 1

Temperature > 38°C 1

Tonsillar exudate or swelling 1

Age 3 to 14 years 1

Age 15 to 44 years 0

Age 45 years and older -1


Complete Diagnostic Approach"portal.nnpbc.com" (PDF).

• Rapid strep test (if available)

• Throat swab for culture and sensitivity

• If the child is greater than 2 years old, culture the throat before treatment or do rapid Strep antigen test (if available); if negative, do throat culture.

• Monospot if suspect vira

Treatment [6]

A sore throat caused by a viral infection usually lasts five to seven days and doesn't require medical treatment"portal.nnpbc.com" (PDF)..

To ease pain and fever, many people turn to acetaminophen may be given every four to six hours as needed but should not be given more than five times in a 24-hour period.,) or other mild pain relievers..

if bacterial infection first choice treatment is penicillin , since GABHS remains universally susceptible to penicillin. Although penicillin V is the drug of choice, ampicillin or amoxicillin are good taste, represent a suitable option in children.


=== Table 4===[5] Therapeutic options for GABHS pharyngitis recommended by American Hearth Association and American Academy of Pediatrics AAP [13,4].

Drug Dose Duration
Penicillins

Penicillin V (oral) • Children <27 kg: 400 000 U (250 mg) 2 to 3 times daily ;

• Children >27 kg, adolescents, and adults: 800 000 (500 mg) 2 to 3 times daily

10 days

Amoxicillin (oral) 50 mg/kg once daily (maximum 1 g) 10 days

Benzathin Penicillin G (intramuscular) • Children <27 kg: 600 000 U (375 mg);

• Children >27 kg, adolescents, and adults: 1 200 000 U (750 mg)

Once

For individuals allergic to penicillin

Narrow-spectrum cephalosporin (cephalexin, cefadroxil) (oral)* Variable 10 days

Clindamycin (oral) 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) 10 days

Azithromycin (oral) 12 mg/kg once daily (maximum 500 mg) 5 days

Clarithromycin (oral) 15 mg/kg per day divided BID (maximum 250 mg BID) 10 days

* Patients with immediate or type I hypersensitivity to penicillin should not be treated with a cephalosporin [4].

Do's[7]

  • Pain reliever :Throat pain can be treated with a mild pain reliever such as acetaminophen ( Tylenol) or a nonsteroidal anti-inflammatory agent such as ibuprofen ( Advil, Motrin)
  • keep hydration:Drinking alot of fluid To reduce the risk of dehydration, parents can offer warm or cold liquids.
  • Other intervention: include sipping warm beverages (eg, honey or lemon tea, chicken soup), cold beverages, or eating cold or frozen desserts (eg, ice cream, popsicles). These treatments are safe for children

Don'ts[8]

  • Aspirin is not recommended for children <18 years due to the risk of a potentially serious condition known as Reye syndrome.
  • Sprays containing topical anesthetics are available to treat sore throat We do not recommend throat sprays for children.
  • medicated throat lozenges are available to relieve dryness or pain it is not clear that lozenges work any better than hard candy. We do not recommend throat lozenges for children, especially children younger than five years, who can choke. Sucking on hard candy may provide some relief for children older than five years, who are not at risk for choking
  • Honey should not be given to children younger than 12 months due to the potential risk of botulism poisoning.

References

  1. Tibballs J, Watson T (2011). "Symptoms and signs differentiating croup and epiglottitis". J Paediatr Child Health. 47 (3): 77–82. doi:10.1111/j.1440-1754.2010.01892.x. PMID 21091577.
  2. Stroud RH, Friedman NR (2001). "An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis". Am J Otolaryngol. 22 (4): 268–75. doi:10.1053/ajot.2001.24825. PMID 11464324.
  3. 4.0 4.1
  4. 5.0 5.1 5.2 Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M (2011). "Update on the management of acute pharyngitis in children". Ital J Pediatr. 37: 10. doi:10.1186/1824-7288-37-10. PMC 3042010. PMID 21281502.
  5. Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M (2011). "Update on the management of acute pharyngitis in children". Ital J Pediatr. 37: 10. doi:10.1186/1824-7288-37-10. PMC 3042010. PMID 21281502.
  6. "UpToDate".
  7. "UpToDate".

https://www.wikidoc.org/index.php/Sore_throat_resident_survival_guide_(pediatrics)#cite_note-pmid21281502-3