Strep/Bacterial Pharyngitis
• Signs and Symptoms of Streptococcal Throat infection
o Fever o Muscle aches and pains (myalgia) o Dysphagia (difficulty swallowing) o Lack of cough (cough is more common with viral pharyngitis) o Swollen and painful anterior cervical nodes in the neck and tonsillar exudates o Absence of watery eyes and runny nose with bacterial pharyngitis o Watery eyes and runny nose—viral pharyngitis
• Streptococcal Pharyngitis Treatment:
o Penicillin sensitive patients: pen vk or amoxicillin • Adult dose: 10 days Rx: 500 mg BID X 10 days • Moxatag: for significant condition amoxicillin extened release tablet; Adult dose 775 mg Moxatag, once daily X 10 days with meal, do not chew or crush tablet→contains 1 immediate release and 2 delayed release amoxicillin formulations→point is that one acts immediately and the other gets slowly released so throughout the day the patient is coverd for the entire day→RENAL COMPETENT PT ONLY→amoxicillin is cleared through the kidney so any concentration above 500 mg per tablet are reserved for patient who has an optimally functioning (100%) kidney o Penicillin Allergy patients • Azitrhomycin (zithromax): 5 days Rx: 500 mg, day 1, then 250 mg/day for 4 days o best time to take loading dose? 2 hours before bedtime because it is easy on the stomach
• Streptococcal pharyngitis diagnosis: confirmed with RADT/throat culture
o Rapid antigen detection test: detects presence of group A streptococcal carbs on a throat swab • 5-10 minutes • less sensitive than throat cutlrue test • + RADT: confirms presence of streptococcal pharyngitis • -RADT: do a follow up throat culture if there is suspicion of step pharyngitis o Throat culture test • Culture on a sheep blood agar plate is the standard test for acute strep pharyngitis • Results in 24-48 hours, 90-95% sensitive
strep pharyngitis vs viral pharyngitis
o Strep pharyngitis: fever, sore throat, dysphagia, lack of cough, swollen painful glands, tonsillar exudates, absence of watery eyes and runny nose o Viral pharyngitis: sore throat associated with watery eyes and runny nose→use antivirals
alpha vs beta hemolytic
• Normal oral flora contains alpha-hemolytic streptococcus or strep viridans • Group A beta-hemolytic streptococcus invading bacteria, causes strep, throat/pharyngitis→this is the organism that is targeted with antibiotics when providing premed prophylaxis o causes strep pharyngitis can ultimately lead to rhematic fever o NOT the cause of rheumatic fever, but can lead to rheumatic fever o This is the organism that is identified when we do a throat culture for strep pharyngitis o Do not treat/incompletely treat strep pharyngitis (stop taking before finished)→beta hemolytic streptococcus causes periarticular reactions→rheumatic fever