RISK FACTORS: Group A beta hemolytic streptococcal epidemics occur, Age (young are more susceptible), Family history, Close quarters, such as in new military recruits, Fatigue, Smoking, Immunosuppression, Excess alcohol consumption
RISK FACTORS
β’ Group A beta hemolytic streptococcal epidemics occur
β’ Age (young are more susceptible)
β’ Family history
β’ Close quarters, such as in new military recruits
β’ Immunosuppression
β’ Fatigue
β’ Smoking
β’ Excess alcohol consumption
β’ Oral sex
β’ Diabetes mellitus
β’ Recent illness
GENERAL MEASURES
β’ Salt water gargles
β’ Acetaminophen
β’ Dyclonine lozenges
β’ Cool-mist humidifier
ACTIVITY As tolerated
DIET No restrictions. Encourage extra fluids.
PATIENT EDUCATION
β’ Important to complete 10 day course of antibiotics regardless of symptom response
β’ Patients presumed to be non-infectious after 24 hours of antibiotic coverage
DRUG(S) OF CHOICE
For streptococcal pharyngitis, penicillin is the standard. All choices should have complete 10 day course.
β’ Penicillin V 250 mg tid (25-50 mg/kg/day), or
β’ For penicillin allergic patients, erythromycin ethylsuccinate 300 to 400 mg tid (30 mg/kg/day), or
β’ Cephalexin 250 mg tid (30 mg/kg/day)
ALTERNATIVE DRUGS
. Treatment of carrier state is diffi cult, usually requiring addition of rifampin to penicillin regimen
. Penicillin is the treatment most documented to prevent rheumatic sequelae but cephalosporins have lower rate of bacteriologic failure
. Bacterial eradication rates . 10 days therapy with penicillin have been achieved with 6 days of amoxicillin
and 5 days with various cephalosporins
. The newer macrolides, azithromycin and clarithromycin, are also effective against streptococcal pharyngitis, but more expensive. The chief advantage of azithromycin is its 5 day course with 10 day effective duration.
. Other cephalosporins are generally effective for streptococcal pharyngitis, but more expensive than cephalexin
PATIENT MONITORING
β’ Routine followup cultures not necessary
β’ Telephone consult for duration of symptoms
PREVENTION/AVOIDANCE Avoid contact with infected people
POSSIBLE COMPLICATIONS
β’ Rheumatic fever
β’ Post-streptococcal glomerulonephritis
β’ Peritonsillar abscess
β’ Systemic infection
β’ Otitis media
β’ Mastoiditis
β’ Septicemia
β’ Rhinitis
β’ Sinusitis
β’ Pneumonia
EXPECTED COURSE/PROGNOSIS
β’ Streptococcal pharyngeal infection runs a 5-7 day course with peak of fever at 2-3 days
β’ Symptoms will resolve spontaneously without treatment, but rheumatic complications are still possible
β’ Suppurative complications such as peritonsillar abscess require surgical intervention