Document Detail

Diagnosis and treatment of streptococcal pharyngitis.
MedLine Citation:
PMID:  19275067     Owner:  NLM     Status:  MEDLINE    
Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4 degrees F (38 degrees C), tonsillar exudates, and cervical adenopathy. Cough, coryza, and diarrhea are more common with viral pharyngitis. Available diagnostic tests include throat culture and rapid antigen detection testing. Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly. The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy. Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice because of cost, narrow spectrum of activity, and effectiveness. Amoxicillin is equally effective and more palatable. Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy. Increased group A beta-hemolytic streptococcus (GABHS) treatment failure with penicillin has been reported. Although current guidelines recommend first-generation cephalosporins for persons with penicillin allergy, some advocate the use of cephalosporins in all nonallergic patients because of better GABHS eradication and effectiveness against chronic GABHS carriage. Chronic GABHS colonization is common despite appropriate use of antibiotic therapy. Chronic carriers are at low risk of transmitting disease or developing invasive GABHS infections, and there is generally no need to treat carriers. Whether tonsillectomy or adenoidectomy decreases the incidence of GABHS pharyngitis is poorly understood. At this time, the benefits are too small to outweigh the associated costs and surgical risks.
Beth A Choby
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American family physician     Volume:  79     ISSN:  0002-838X     ISO Abbreviation:  Am Fam Physician     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-11     Completed Date:  2009-04-14     Revised Date:  2014-07-25    
Medline Journal Info:
Nlm Unique ID:  1272646     Medline TA:  Am Fam Physician     Country:  United States    
Other Details:
Languages:  eng     Pagination:  383-90     Citation Subset:  AIM; IM    
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MeSH Terms
Anti-Bacterial Agents / therapeutic use*
Nephritis / etiology
Pharyngitis / drug therapy,  microbiology*
Practice Guidelines as Topic
Rheumatic Fever / etiology
Streptococcal Infections / complications,  diagnosis*,  drug therapy*
Streptococcus pyogenes / isolation & purification*
Reg. No./Substance:
0/Anti-Bacterial Agents
Comment In:
Am Fam Physician. 2010 Jun 1;81(11):1318; author reply 1318   [PMID:  20521748 ]
Erratum In:
Am Fam Physician. 2013 Aug 15;88(4):222
Note: Dosage error in article text

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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