- Diff dx: Viral, mono, strep, F necrophorum, HIV
- Natural hx of pharyngitis 3-5 days
- No Macrolides
- F necrophorum as common as GAS in adolescents and young adults. One in 400 progress to Lemiere's (septic thrombophlebitis of IJ) with 5% mortality rate. Always treat with abx anyone with rigors, night sweats or other signs of bacteremia. Per Centor, R., //Ann IM, 2009
In patients with pharyngitis, the 4-point Centor criteria are used to estimate the risk for group A streptococcal infection and to determine whether additional testing or treatment is indicated. One point is given for each of the following criteria: fever, absence of cough, tender cervical lymphadenopathy, and tonsillar exudate. A score of 0 is associated with a risk for streptococcal infection that is less than 2.5%; a score of 3 or 4 is associated with risk of infection between 28% and 53%. For patients with a score of 0 (as in this scenario), no testing or treatment is recommended. For patients who have a score ≥2, testing by rapid antigen-detection test and throat culture (and treating if positive) is recommended. For patients with a score of 3 or 4, the guidelines about empiric treatment vary.
For diagnosed group A streptococcal pharyngitis, penicillin is the treatment of choice. Azithromycin is an alternative for penicillin-allergic patients.
Antistreptococcal antibodies help support a diagnosis of acute rheumatic fever or poststreptococcal glomerulonephritis by confirming recent group A streptococcal infection, but these tests are not useful in establishing acute infection.
Wessels MR. Clinical practice. Streptococcal pharyngitis. N Engl J Med 2011 Feb 18; 364:648.