Sore throat resident survival guide
|Sore throat Resident Survival Guide Microchapters|
Synonyms and keywords: An approach to sore throat in adults, Sore throat approach in adults, Approach to pharyngitis in adults, Pharyngitis in adults
Sore throat, also called as pharyngitis, is a painful sensation in the back part of the throat due to inflammation of the pharynx. It is one of the most frequent complaints among patients visiting their primary care physicians. In the United States, approximately 12 million ambulatory care visits are due to sore throat annually. The majority of cases occur in children and adolescents. The etiology is acute self- limiting viral infection in the majority of individuals. Group A streptococcal infection is the usual causative bacteria for acute pharyngitis in adults. As a physician, it is important to identify clinical signs for life-threatening airway obstruction and deep tissue infection and treat them promptly. This section provides a short and straight to the point overview of the sore throat in adults.
- Viral upper respiratory tract infection (adenovirus, rhinovirus, coronavirus, enterovirus, influenza A and B, parainfluenza virus, respiratory syncytial virus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
- Group A streptococcal (GAS) infection
- Group C and G Streptococcus infection
- Arcanobacterium haemolyticum
- Fusobacterium necrophorum - which causes the Lemierre's syndrome
- Mycoplasma and Chlamydia species
- Corynebacterium diphtheriae
- Acute HIV infection
- Neisseria gonorrhoeae
- Epstein-Barr virus and other herpes viruses such as: cytomegalovirus (CMV) and herpes simplex virus (HSV)
- Allergic rhinitis, sinusitis
- Gastroesophageal reflux disease
- Inhalation of dry air (particularly in winters)
- Vocal strain
- Medications: Angiotensin-converting enzyme inhibitors, chemotherapeutic drugs
Are there alarming clinical signs for upper airway obstruction or deep neck infection present?
|Manage patient with supportive care.|
Does patient have clinical features of GAS throat infection?
|Apply Centor criteria for patient's clinical signs and symptoms. Is score ≥3?|
|Perform Rapid antigen detection test (RADT)||Consider other viral, bacterial or noninfectious causes of sore throat. The illness is mostly self-limiting and specific tests for diagnosis are not carried out.|
|GAS pharyngitis confirmed - start antibiotics|
Perform throat culture in patients with any of the following risk factors:
|Does patient have strong clinical suspicion for viral URTI?|
|Is patient having symptoms suggestive of GAS pharyngitis along with positive RADT?||Manage patient with supportive care including analgesics, hot fluids, lozenges, and soft diet.|
If patients are allergic to penicillin:
- Physicians should administer antibiotics with judicious care in patients with a sore throat due to the risk of developing adverse reactions and bacterial resistance in the community. A physician should only prescribe antibiotics in patients with high clinical suspicion for GAS or those with positive rapid antigen detection test and throat culture.
- Antibiotics reduce the severity of symptoms and fasten the rate of recovery in the patients. The primary goal of treatment with antibiotics is to reduce the incidence of complications with GAS infection.
- The Infectious Disease Society of America (IDSA) has recommended the use of aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or acetaminophen as supportive therapy for alleviation of pain. The randomized clinical trials have shown NSAIDs as a more effective option for the relief of symptoms compared to acetaminophen.
- If there are alarm signs such as stridor and coughing or drooling assess for croup or epiglottitis and give emergent medical support.
- The oral glucocorticoids should not be prescribed to patients as their adverse effects outweigh their benefits as an oral analgesics.
- Glucocorticoids should only be considered in patients with significant odynophagia and dysphagia.
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|pmc=value (help). PMID 32329971 Check
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