Pharyngitis

📚Definitions 

Pharyngitis: Inflammation of the pharynx, presenting as sore throat.

🗺️ Overview

• Viral causes (most common): Rhinovirus, adenovirus, influenza, EBV, CMV.

   

• Bacterial causes (15-20% of cases): Group A Streptococcus (GAS) is the primary treatable pathogen.

   

• Key distinctions:
  • GAS pharyngitis: Sudden onset, fever, tonsillar exudate, tender cervical nodes, no cough.
  • Viral pharyngitis: Gradual onset, cough, rhinorrhea, hoarseness.

🔑 Key Reminders (2025)

• Antibiotic stewardship: Use Centor Criteria to guide testing/treatment.
• Avoid corticosteroids unless severe airway compromise.
• 10-day antibiotic course for confirmed GAS (prevents rheumatic fever).

✏️ Assessment  

History

• Symptoms: Fever, sore throat, cough, nasal congestion, fatigue, rash.
• Red flags: Drooling, stridor, neck swelling, toxic appearance.
• Risk factors: Recent GAS exposure, rheumatic fever history, immunocompromised.

Examination (Telehealth Adaptations)

• Visual inspection (webcam/digital photo): Tonsillar exudate, swelling, uvular deviation.
• Lymph nodes: Tender anterior cervical adenopathy.
• Voice: "Hot potato" voice (suggests peritonsillar abscess).

🚨 Centor Criteria for GAS Risk Stratification

Interpretation

• Score ≤1: Low risk (1–10% GAS) → No testing/antibiotics.

• Score 2–3: Moderate risk (11–35%) → Test (rapid strep/culture).

• Score ≥4: High risk (51–53%) → Empiric antibiotics or confirmatory testing.
   

💆 Treatment 

If clinical or epidemiological factors raise high suspicion for GAS pharyngitis it is appropriate to start antibiotic treatment without RSAT or throat culture if in-person care is not mandated or required clinically.

• Patients with a Centor score of 4 (15 years and above) may be treated empirically at the clinician’s discretion

• Patients with a high Centor score and a rapid strep or culture positive contact in the home may be treated

• Otherwise, the presence of GAS should be confirmed by RSAT or throat culture prior to starting antibiotics.

   

Viral Pharyngitis

• Symptomatic care:

1.  
   1. NSAIDs (ibuprofen) or acetaminophen for pain/fever.
   2. Throat lozenges, hydration.

   3. Avoid: Antibiotics, steroids (unless airway compromise).

       

GAS Pharyngitis

• First-line:

1.  
   1. Penicillin V: 500 mg BID/TID × 10 days (adults);
   2. Amoxicillin: 50 mg/kg once daily × 10 days (preferred for pediatrics).

• Penicillin allergy:

1.  
   1. Cephalexin (non-anaphylactic allergy).

   2. Clindamycin or azithromycin (if severe allergy).

       

• Red Flags Requiring Referral

1.  
   1. Emergent: Stridor, drooling, neck stiffness, toxic appearance.
   2. High-risk patients: Infants <3 months, immunocompromised, worsening on antibiotic

 🛑 Prevention  

• Vaccination: Influenza, pneumococcal (for high-risk patients).
• Hygiene: Handwashing, avoid close contact during outbreaks.

 🔮 Follow Up 

• Routine: Not needed if symptoms resolve.
• Referral: Persistent symptoms, recurrent episodes, or complications.

📘 Coding

ICD-10 Codes: 

• J02.0: Streptococcal pharyngitis
• J02.9: Acute pharyngitis, unspecified

If you have any questions or would like more information, please reach out to the Delegating Physician.