Introduction Centor criteria (fever >°C, swollen, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough) are an algorithm to assess the. People with a sore throat caused by streptococcal bacteria are more likely to benefit from antibiotics. FeverPAIN or Centor criteria are clinical. Richard Tang reveals how the Modified Centor Score can aid in your diagnosis when URTIs present to the ED and how it can help guide your.

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This is a corrected version of the article that appeared in print. See related handout on strep throatwritten by the authors of this article. The strongest independent predictors of GABHS pharyngitis are patient age of five ctiteria 15 years, absence of cough, tender anterior cervical adenopathy, tonsillar exudates, and fever.

Patients allergic to penicillin can be treated with first-generation cephalosporins, clindamycin, or macrolide antibiotics.

Nonsteroidal anti-inflammatory drugs are more effective than acetaminophen and placebo for treatment of fever and pain associated with GABHS pharyngitis; medicated throat lozenges used every two hours are also effective. Corticosteroids provide only a small reduction in the duration of symptoms and should not be used routinely.

Diagnosis and Treatment of Streptococcal Pharyngitis

Pharyngitis is diagnosed in 11 million persons in the outpatient setting each year in the United States. Physicians should diagnose GABHS pharyngitis using an approach that combines a cebtor clinical decision rule e. Centoor treatment of GABHS pharyngitis can include medicated throat lozenges, nonsteroidal anti-inflammatory drugs, and topical anesthetics. For information about the SORT evidence rating system, go to https: Children five to 15 years of age who have been exposed in the past 72 hours to someone with GABHS infection are at highest risk.

GABHS pharyngitis should be suspected in patients with fever, tonsillar exudates, absence of cough, intensely inflamed ventor, acute onset, and tender anterior adenopathy.

Adapted with permission from Choby BA. Diagnosis and treatment of streptococcal pharyngitis [published correction appears in Am Fam Physician. No testing or treatment needed; consider backup throat culture in children three to 15 years of age. Information from reference A systematic review of the clinical diagnosis of GABHS pharyngitis found that clinical characteristics, seasonality, and age can help differentiate GABHS infection from other etiologies of sore throat. Additionally, herpangina and hand-foot-and-mouth disease occur more often in the summer and are more common in dentor younger than five years.

However, infectious mononucleosis is more common in persons 10 to 30 years of age and is associated with fatigue, crireria cervical adenopathy, and atypical lymphocytosis. Clinical characteristics of different types critreia pharyngitis. A Streptococcal pharyngitis in a year-old girl demonstrates tonsillar exudates and hypertrophy. C Viral pharyngitis in a year-old girl demonstrates erythematous tonsils without hypertrophy or exudates.

The best data for the diagnosis of GABHS pharyngitis come from studies that combine age, signs, and symptoms to determine the likelihood of disease. These clinical decision rules will be discussed in more detail. Patients at low risk of GABHS pharyngitis can be treated symptomatically, RADT should be ordered for those at intermediate risk, and empiric antibiotics are an option for those at high risk. The modified Centor score adds critegia additional point for patient age of three to 14 years and subtracts one point for patients older than 45 years.


Table 2 describes testing and treatment guidelines from different groups. Oral penicillin V; intramuscular penicillin G benzathine; oral amoxicillin is as effective as penicillin and has better palatability in children. Information from references 323and If RADT results are negative, patients should be treated symptomatically and asked to return if symptoms persist after five days or worsen.

If symptoms dentor beyond five days, patients should be evaluated for signs and symptoms of infectious mononucleosis, peritonsillar abscess, and human immunodeficiency virus infection. If a throat culture was not performed during the initial visit, it should be ordered at this time. A retrospective study analyzed data from centoor inpatients with sore throat who presented to a pharmacy-based clinic. Backup throat cultures are not needed for adults with negative RADT results.

Because children are at higher risk of complications such as peritonsillar abscess, rheumatic fever, and poststreptococcal glomerulonephritis, backup throat cultures are recommended for criteeria with negative RADT results.

When using one of the newer highly sensitive optical immunoassay or molecular tests, a backup culture critsria of little value, even in children, and may be omitted. Physicians should be aware of the type of RADT used in their clinical setting. The guidelines from the IDSA recommend backup throat cultures in children with negative RADT results to avoid the ceiteria of complications such as peritonsillar abscess, rheumatic fever, and poststreptococcal glomerulonephritis.

If backup culture is not performed, patients should be advised to return for further evaluation if symptoms persist for more than five days. At that time, further testing, including a throat culture, should be performed. For patients with type IV hypersensitivity reactions to penicillin e. Patients with type I hypersensitivity reactions i.

These infections are usually a result of noncompliance with treatment. If a first-generation cephalosporin e. A Cochrane review studied 17 trials with 5, participants and compared penicillin and a cephalosporin as first-line treatments for GABHS pharyngitis.

Cephalosporins should be used for patients with delayed allergic reactions to penicillin.

A Cochrane review comparing a three- to six-day course of antibiotics with a day course found similar effectiveness between groups. However, in areas with a higher prevalence of rheumatic fever, a day course of penicillin should be prescribed. Clindamycin is a reasonable option for treating patients with type I immunoglobulin E—mediated reactions to penicillin Table 3.

Erythromycin is associated with substantially higher rates of gastrointestinal adverse effects than other antibiotics. Antibiotic-resistant strains of GABHS infection are widespread in some areas of the world and have resulted in treatment failures. None were resistant to clindamycin. Treatment for patients with type IV hypersensitivity to penicillin. Treatments for patients with type I hypersensitivity to penicillin.


Generic price listed first; brand name in parentheses, if available. Information from references 132324and 28 through Medicated throat lozenges are effective when used every two hours. Tonsillectomy is recommended critreia a small subgroup of patients with recurrent streptococcal pharyngitis.

It should be considered in patients with a high frequency of throat infections, allergic reactions to multiple antibiotic treatments, or a history of peritonsillar abscess. Because most episodes of pharyngitis spontaneously decrease after the age of 10 years, patients should be judiciously referred for this invasive procedure. The American Academy xriteria Otolaryngology—Head and Neck Surgery released a clinical practice guideline in that listed the indications for tonsillectomy.

Tonsillectomy is also recommended in patients who are difficult to treat medically, including those who are allergic to multiple antibiotics. Tonsillectomy may result in multiple morbidities, including hemorrhage, delayed feeding, and fever. The short-term effectiveness of tonsillectomy is minimal. A Cochrane review of seven trials and participants found that patients who did not undergo tonsillectomy had 3. The search included meta-analyses, cebtor controlled trials, and reviews.

Food and Drug Administration website. References from within those sources, as well as from UpToDate, were also searched. September 15,to April 18, This article updates previous articles on this topic by Choby 1 ; Vincent, et al.

Already a member or subscriber? Address correspondence to Monica G. Reprints are not available from the authors. Ambulatory medical care utilization estimates for National Health Statistics Reports. Accessed March 8, Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: N Engl J Med.

Prevalence of streptococcal pharyngitis and streptococcal carriage in children: Chronic pharyngeal carriage of group A streptococci. Pediatr Infect Dis J. Incidence of streptococcal carriers in private pediatric practice. Arch Pediatr Adolesc Med. Evaluation and treatment of pharyngitis in primary care practice: The rational clinical examination. ventor

Common Questions About Streptococcal Pharyngitis – – American Family Physician

Does this patient have centoor throat? Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: Emergency evaluation and management cntor the sore throat.

Emerg Med Clin North Am. Clinical features of Epstein-Barr virus-associated infectious mononucleosis in hospitalized Korean children. Prospective study of the natural history of infectious mononucleosis caused by Epstein-Barr virus. J Am Board Fam Pract. Clinical and epidemiological characteristics of adult hand, foot, and mouth disease in northern Zhejiang, China, May —November Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus centof in Taiwan, — Etiologic and epidemiologic analysis of hand, foot, and mouth disease in Guangzhou city: Braz J Infect Dis.

A clinical score to reduce unnecessary antibiotic use in patients with sore throat. Clinical features, diagnosis, and management of enterovirus Enteroviruses isolated from herpangina and hand-foot-and-mouth disease in Korean children.