Strep Throat

Centor Criteria to assess risk of strep and to determine if culture should be sent

Exudative pharyngitis Fever Tender anterior cervical LAD Absence of cough Modifier: <15 years old --> add 1 point >44 years old --> subtract 1 point Abx at 4-5, culture 2-3 and symptomatic tx -1-1

Signs and symptoms of Strep throat

Sudden onset of sore throat Age 5-15 years (most common) Fever Headache Nausea, vomiting, abdominal pain Tonsillopharyngeal inflammation Patchy tonsilar exudates Palatal petechiae Tender nodes History of exposure Scarlatiniform rash Edematous uvula

When should a patient return for strep if they are not seeing improvements on antibiotics

48-72 hours

Treatment for strep in pediatric patient who can swallow pills (<60 lbs or >60 lbs)

< 60 lbs Penicillin VK 250 mg orally twice daily for 10 days (*alternate* Benzathine Penicillin 600,000 IU IM x 1 dose) > 60 lbs Penicillin VK 500 mg orally BID X 10 days (*alternate* Benzathine Penicillin 1.2 million IU IM x 1 dose)

Pediatric Alternative antibiotics for strep if penicillin allergy?

1. Cephalexin 20 mg/kg BID x 10 days (max 100mg daily) 2. Azithromycin 12 mg/kg once daily x 5 days (max 500 mg daily) 3. Clindamycin 7 mg/kg TID x 10 days (max 900 mg daily)

Adult treatment of Strep

1. Penicillin V 250 mg orally 4 times daily or 500 mg BID for 10 days 2. Amoxicillin 1000 mg once daily or 500 mg BID for 10 days

Treatment for step in a child who cannot swallow pills

Amoxicillin Suspension 50mg/kg once daily for 10 days (max 1000 mg daily)

Adult strep treatment alternatives if penicillin allergay

Clindamycin 300 mg TID for 10 days Cephalexin 500 mg BID x 10 days Azithromycin 500 mg once daily for 5 days

Criteria for tonsillectomy

≥7 sore throat episodes in the past year OR ≥5 episodes in each of preceding 2 years OR ≥3 episodes in each of preceding 3 years.