#ir #peds
Diagnosis and Treatment of Group A Streptococcus Pharyngitis
Pharyngitis secondary to group A beta-hemolytic Streptococcus (Streptococcus pyogenes) (GAS)
is a common pediatric infection. Though the acute illness is usually self-limited, diagnosis and
treatment are important to prevent potential serious sequelae, especially rheumatic fever.
Diagnosis
Patients in whom the diagnosis is suspected should have diagnostic testing performed.
A "rapid strep" test detects a streptococcal antigen from a throat swab obtained by swabbing
the tonsils and posterior pharynx. This test is highly specific, but there is variable sensitivity.
A positive rapid strep test generally does not require any further laboratory confirmation;
however, a negative result should be confirmed by standard throat culture.
Initiating Antibiotics
Ideally, there should be documentation of infection with GAS prior to initiating antibiotics. However,
some physicians will treat patients with antibiotics based on a clinical diagnosis of GAS pending
results of the culture. Others will wait for culture results in the setting of a negative rapid strep test.
Appropriate antibiotics started within nine days from the start of the acute illness will prevent acute
rheumatic fever.
11/15
Antibiotic Selection
Although penicillin is the drug of choice for GAS pharyngitis, the suspension form does not have a
pleasant taste. Therefore, many physicians opt for oral amoxicillin, which is more palatable.
In a child who refuses oral medications or when adherence to a 10-day regimen will be difficult for
the family, a single intramuscular injection of penicillin may be the best option.
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CLIPP 11 - Kawasakiia, secondary to a sterile urethritis, is associated with Kawasaki disease. A cleancatch
urine is likely to show white cells, whereas a catheterized urine may not (because the white
cells come from the urethra).
Management
<span>Diagnosis and Treatment of Group A Streptococcus Pharyngitis
Pharyngitis secondary to group A beta-hemolytic Streptococcus (Streptococcus pyogenes) (GAS)
is a common pediatric infection. Though the acute illness is usually self-limited, diagnosis and
treatment are important to prevent potential serious sequelae, especially rheumatic fever.
Diagnosis
Patients in whom the diagnosis is suspected should have diagnostic testing performed.
A "rapid strep" test detects a streptococcal antigen from a throat swab obtained by swabbing
the tonsils and posterior pharynx. This test is highly specific, but there is variable sensitivity.
A positive rapid strep test generally does not require any further laboratory confirmation;
however, a negative result should be confirmed by standard throat culture.
Initiating Antibiotics
Ideally, there should be documentation of infection with GAS prior to initiating antibiotics. However,
some physicians will treat patients with antibiotics based on a clinical diagnosis of GAS pending
results of the culture. Others will wait for culture results in the setting of a negative rapid strep test.
Appropriate antibiotics started within nine days from the start of the acute illness will prevent acute
rheumatic fever.
11/15
Antibiotic Selection
Although penicillin is the drug of choice for GAS pharyngitis, the suspension form does not have a
pleasant taste. Therefore, many physicians opt for oral amoxicillin, which is more palatable.
In a child who refuses oral medications or when adherence to a 10-day regimen will be difficult for
the family, a single intramuscular injection of penicillin may be the best option.
Treatment of Kawasaki Disease
Aspirin and intravenous immune globulin (IVIG) have been the standard therapy for Kawasaki
disease for many years.
Aspirin
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