Sore throat resident survival guide (pediatrics): Difference between revisions

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==Overview==
==Overview==
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Sore throat is an acute upper respiratory tract infection that affects the respiratory mucosa of the throat.


==Causes==
==Causes==

Revision as of 05:59, 17 August 2020


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

Sore throat resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

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

Causes

Life Threatening Causes

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

Common Causes

Bacteria

  • Streptococcus( group A beta-haemolytic )
  • Haemophilus influenzae
  • Moraxella catarrhalis

viruses[1]

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

chemical irritation[1]

  • nasogastric tubes.
  • smoke.

FIRE: Focused Initial Rapid Evaluation


Table 1

Clinical signs and symptoms of GABSH pharingitis , their sensitivity and specificity [5]

Symptoms and Clinical Findings Sensitivity (%) Specificity (%)
Absence of cough 51-79 36-68

Anterior cervical nodes swollen or enlarged 55-82 34-73

Headache 48 50-80

Myalgia 49 60

Palatine petechiae 7 95

Pharyngeal exudates 26 88

Fever >38°C 22-58 52-92

Tonsillar exudate 36 85


Table 2

Clinical Score for GABSH pharyngitis.

Reference Clinical signs and symptoms Sensibility (%) Specificity (%)
[37] Recent exposure to GABHS, pharyngeal exudate, enlarged or tender cervical nodes, fever 55 74

[38] Season, age, white cells count, fever, absence of cough, enlarged cervical nodes, tonsillar exudate or swelling 68 85

[39] Swollen and tender anterior cervical nodes, tonsillar exudate 84 40

[40] Fever, cervical nodes enlargement, tonsillar exudate or swelling or hypertrophy, Absence of cough 63 67

[41] Season, age, fever, enlarged cervical nodes, tonsillar exudate or swelling or hypertrophy, absence of cough or rhinitis or conjunctivitis 22 93

[42] Tonsillar hypertrophy, enlarged cervical nodes, absence of rhinitis, scarlet fever rash 18 97

Table 3

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"portal.nnpbc.com" (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

penicillin is first choice treatment, 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

Therapeutic options for GABHS pharyngitis recommended by American Hearth Association and American Academy of Pediatrics AAP [13,4].

Drug Dose Duration
Penicillins

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)

Once

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].

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

  1. 1.0 1.1


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