Sore throat resident survival guide (pediatrics)
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
| 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 hearth 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 .
Common Causes
Bacteria
- Streptococcus( group A beta-haemolytic ) most commonly [1]
- Haemophilus influenzae
- Moraxella catarrhalis
viruses[2]
- Rhinovirus
- coronavirus.
- respiratory syncytial virus.
- metapneumovirus.
- Epstein–Barr virus.
chemical irritation[2]
- nasogastric tubes.
- smoke.
FIRE: Focused Initial Rapid Evaluation
=== Table 1=== Clinical signs and symptoms of GABSH pharingitis , their sensitivity and specificity [5]
| Symptoms and Clinical Findings | Sensitivity (%) | Specificity (%) |
|---|---|---|
| Absence of cough | 51-79 | 36-68 |
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| Anterior cervical nodes swollen or enlarged | 55-82 | 34-73 |
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| Headache | 48 | 50-80 |
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| Myalgia | 49 | 60 |
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| Palatine petechiae | 7 | 95 |
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| Pharyngeal exudates | 26 | 88 |
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| Fever >38°C | 22-58 | 52-92 |
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| Tonsillar exudate | 36 | 85 |
=== Table 2===[3][3]
Clinical Score for GABSH pharyngitis.
| Reference | Clinical signs and symptoms | Sensibility (%) | Specificity (%) |
|---|---|---|---|
| [37] | Recent exposure to GABHS, pharyngeal exudate, enlarged or tender cervical nodes, fever | 55 | 74 |
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| [38] | Season, age, white cells count, fever, absence of cough, enlarged cervical nodes, tonsillar exudate or swelling | 68 | 85 |
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| [39] | Swollen and tender anterior cervical nodes, tonsillar exudate | 84 | 40 |
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| [40] | Fever, cervical nodes enlargement, tonsillar exudate or swelling or hypertrophy, Absence of cough | 63 | 67 |
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| [41] | Season, age, fever, enlarged cervical nodes, tonsillar exudate or swelling or hypertrophy, absence of cough or rhinitis or conjunctivitis | 22 | 93 |
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| [42] | Tonsillar hypertrophy, enlarged cervical nodes, absence of rhinitis, scarlet fever rash | 18 | 97 |
=== Table 3 ===[3][3] Centor Score.[3]
| Clinical criteria | Points |
|---|---|
| Absence of cough | 1 |
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| Swollen and tender anterior cervical nodes | 1 |
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| Temperature > 38°C | 1 |
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| Tonsillar exudate or swelling | 1 |
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| Age 3 to 14 years | 1 |
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| Age 15 to 44 years | 0 |
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| 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==[3] penicillin is first choice treatment, 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===[3] Therapeutic options for GABHS pharyngitis recommended by American Hearth Association and American Academy of Pediatrics AAP [13,4].
| Drug | Dose | Duration |
|---|---|---|
| Penicillins | ||
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| 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 |
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| Amoxicillin (oral) | 50 mg/kg once daily (maximum 1 g) | 10 days |
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| 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 |
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| For individuals allergic to penicillin | ||
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| Narrow-spectrum cephalosporin (cephalexin, cefadroxil) (oral)* | Variable | 10 days |
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| Clindamycin (oral) | 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) | 10 days |
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| Azithromycin (oral) | 12 mg/kg once daily (maximum 500 mg) | 5 days |
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| 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
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.