SORE THROAT(rhinorrhea) Dr Eoghan O’Shea

NEJM 2011;34: STREPTOCOCCAL PHARYNGITIS DR MICHAEL R. WESSELS

10 YEAR OLD GIRL C/O SORE THROAT AND FEVER X 1/7

HISTORY NKDA NO SURGERIES NO MEDICAL RX NIL FAMILY HISTORY NON CONTRIB

FINDINGS T= 39 TENDER BILAT ANT CERVICAL LYMPH GLANDS TONSILS RED,WHITE YELLOW EXUDATES NORMAL EARS CHEST CLEAR

NOW WHAT ? THINC VD VINDICATE

CAUSES INFECTIOUS NON INFECTIOUS e.g. allergic or chronic rhinitis.OTHER :TRAUMA,FOREIGN BODY,NEOPLASM

ORGANISMS VIRAL BACTERIAL OTHER

VIRUS RHINO INFLUENZA COXSACKIE hand foot and mouth HERPES SIMPLEX gingivostomatitis EBV mono CMV mono like HIV

BACTERIA GROUP A STREP pharyngitis, scarlet fever GROUP C,G pharyngitis MIXED ANEROBES vincents angina FUSOBACTERIUM lemierre’s syndrome septic thrombophlebitis of int jug vein STI g.c.,chlamydia,treponema pallidum

SCORING SYSTEM CRITERIA POINTS T > 38 1 ABSENCE OF COUGH 1 ANT CERVIC GLANDS 1 TONS SWELLING EXUDATE 1 AGE 3<15 1 AGE AGE >45 -1

RISK POINTS %

Mono ?? Rash with AMOXIL CBC,MONOSPOT SWAB RAPID ANTIGEN DETECTION TEST

ANTIBIOTICS DRUG DOSE,ROUTE,DURATION PEN V <27 KG 40mg/kg/day bid-tid AMOXIL 40 mg/kg/day bid-tid To prevent rheumatic fever 10 days

Penicillin allergy Clarithromycin Azithromycin Erythromycin Cephalexin Cefadroxil Clindamycin

Miscellaneous In India, rheumatic fever still an issue,use IM PEN G Know if you have access to rapid antigen- detection test.Positive test very useful.If neg in adults,no further rx,in children:SWAB