Sore throat resident survival guide (pediatrics)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Asia Alriashi, MD[2]

Synonyms and keywords:

Sore throat resident survival guide (pediatrics) Microchapters


Sore throat is an acute upper respiratory tract infection that affects the respiratory mucosa of the throat.


if left untreated cause acute rheumatic fever (ARF), According to WHO, at least 15.6 million people have rheumatic heart 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.

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Differentiating croup and epiglottitis[1][2]
Croup Epiglottitis
Clinical features Acute stridor with coughing and lack of drooling Acute stridor with drooling and lack of coughing
Course Slow-developing airway obstruction - rare severe obstruction Rapidly courses with complete airway obstruction and shock
Imaging Steeple sign in an anterior-posterior neck x-ray Thumb sign in a lateral neck x-ray
Additional clinical features

(less reliable for diagnostic)

Sore throat
  • Barking cough
Sore throat
  • Sitting position
  • Refusal of food or drink
  • Inability to swallow
Treatment Nebulization of racemic epinephrine: Medical emergency:

Common Causes


  • Streptococcus( group A beta-haemolytic ) most commonly [3]
  • Haemophilus influenzae
  • Moraxella catarrhalis


  • Rhinovirus
  • coronavirus.
  • respiratory syncytial virus.
  • metapneumovirus.
  • Epstein–Barr virus.

chemical irritation[4]

  • nasogastric tubes.
  • smoke.

FIRE: Focused Initial Rapid Evaluation

=== Table 1=== Clinical signs and symptoms of GABSH pharingitis , their sensitivity and specificity

Symptoms and Clinical Findings
Absence of cough

Anterior cervical nodes swollen or enlarged



Palatine petechiae

Pharyngeal exudates

Fever >38°C

Tonsillar exudate

=== Table 2===[3][5] Clinical Score for GABSH pharyngitis.

Clinical signs and symptoms
Recent exposure to GABHS, pharyngeal exudate, enlarged or tender cervical nodes, fever

Season, age, white cells count, fever, absence of cough, enlarged cervical nodes, tonsillar exudate or swelling

Swollen and tender anterior cervical nodes, tonsillar exudate

Fever, cervical nodes enlargement, tonsillar exudate or swelling or hypertrophy, Absence of cough

Season, age, fever, enlarged cervical nodes, tonsillar exudate or swelling or hypertrophy, absence of cough or rhinitis or conjunctivitis

Tonsillar hypertrophy, enlarged cervical nodes, absence of rhinitis, scarlet fever rash

=== Table 3 ===[3][5] Centor Score,

Clinical criteria Points
Absence of cough 1

Swollen and tender anterior cervical nodes 1

Temperature > 38°C 1

Tonsillar exudate or swelling 1

Age 3 to 14 years 1

Age 15 to 44 years 0

Age 45 years and older -1

Complete Diagnostic Approach"" (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 [6]

A sore throat caused by a viral infection usually lasts five to seven days and doesn't require medical treatment"" (PDF)..

To ease pain and fever, many people turn to acetaminophen may be given every four to six hours as needed but should not be given more than five times in a 24-hour period.,) or other mild pain relievers..

if bacterial infection first choice treatment is penicillin , 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===[5] Therapeutic options for GABHS pharyngitis recommended by American Hearth Association and American Academy of Pediatrics AAP [13,4].

Drug Dose Duration

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

Amoxicillin (oral) 50 mg/kg once daily (maximum 1 g) 10 days

Benzathin Penicillin G (intramuscular) • Children <27 kg: 600 000 U (375 mg);

• Children >27 kg, adolescents, and adults: 1 200 000 U (750 mg)


For individuals allergic to penicillin

Narrow-spectrum cephalosporin (cephalexin, cefadroxil) (oral)* Variable 10 days

Clindamycin (oral) 20 mg/kg per day divided in 3 doses (maximum 1.8 g/d) 10 days

Azithromycin (oral) 12 mg/kg once daily (maximum 500 mg) 5 days

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].


  • Pain reliever :Throat pain can be treated with a mild pain reliever such as acetaminophen ( Tylenol) or a nonsteroidal anti-inflammatory agent such as ibuprofen ( Advil, Motrin)
  • keep hydration:Drinking alot of fluid To reduce the risk of dehydration, parents can offer warm or cold liquids.
  • Other intervention: include sipping warm beverages (eg, honey or lemon tea, chicken soup), cold beverages, or eating cold or frozen desserts (eg, ice cream, popsicles). These treatments are safe for children


  • Aspirin is not recommended for children <18 years due to the risk of a potentially serious condition known as Reye syndrome.
  • Sprays containing topical anesthetics are available to treat sore throat We do not recommend throat sprays for children.
  • medicated throat lozenges are available to relieve dryness or pain it is not clear that lozenges work any better than hard candy. We do not recommend throat lozenges for children, especially children younger than five years, who can choke. Sucking on hard candy may provide some relief for children older than five years, who are not at risk for choking
  • Honey should not be given to children younger than 12 months due to the potential risk of botulism poisoning.


  1. Tibballs J, Watson T (2011). "Symptoms and signs differentiating croup and epiglottitis". J Paediatr Child Health. 47 (3): 77–82. doi:10.1111/j.1440-1754.2010.01892.x. PMID 21091577.
  2. Stroud RH, Friedman NR (2001). "An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis". Am J Otolaryngol. 22 (4): 268–75. doi:10.1053/ajot.2001.24825. PMID 11464324.
  3. 4.0 4.1
  4. 5.0 5.1 5.2 Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M (2011). "Update on the management of acute pharyngitis in children". Ital J Pediatr. 37: 10. doi:10.1186/1824-7288-37-10. PMC 3042010. PMID 21281502.
  5. Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M (2011). "Update on the management of acute pharyngitis in children". Ital J Pediatr. 37: 10. doi:10.1186/1824-7288-37-10. PMC 3042010. PMID 21281502.
  6. "UpToDate".
  7. "UpToDate".