Streptococcal
pharyngitis is common in
children and
adolescents. It is strongly suggested by the presence of
fever, tonsillar
exudate, tender enlarged anterior cervical
lymph nodes and absence of
cough (Centor criteria). 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.
Treatment of acute streptococcal
pharyngitis is important for preventing
acute rheumatic fever and suppurative
complications, hastening illness resolution, and preventing
transmission.
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.