Pharyngitis

Pharyngitis is an inflammation of the throat often caused by

infection.
Acute pharyngitis is responsible for 1% to 2% of physician visits in adults
and 6% to 8% of pediatric visits, but it is generally self-limited.

Antibiotics are frequently prescribed because it can be difficult to clinically

distinguish between viral and bacterial infection and the fear of untreated
streptococcal illness

Other conditions, such as gastroesophageal reflux, postnasal drip, or

allergies, also can cause sore throat and must be distinguished from
infectious causes.
EPIDEMIOLOGY AND ETIOLOGY
Pharyngitis is a common manifestation of viral URIs.

Streptococcus pyogenes (Group A streptococci) is the most common bacterial cause,

responsible for 20% to 30% of cases in children and 5%
to 15% of adult infections.
Risk factors for group A streptococcal pharyngitis:
• Age 5 to 15 years old are most susceptible,
• Parents of school-age children, People who work with children
Pharyngitis in a child < 3 years rarely due to group A Streptococcus.

It is most common in late winter and early spring and spreads easily through direct
contact with contaminated secretions.
Clusters of infection are common within families, classrooms, and other crowded settings
Symptoms of streptococcal pharyngitis usually are self-limited and resolve
within a few days of onset without antibiotic treatment.

Historically, untreated or inappropriately treated infection caused acute

rheumatic fever, heart valve damage, and other infectious complications.

Delayed antibiotic therapy given up to 9 days after symptom onset can

prevent these sequelae, so proper diagnosis is important to minimize
unnecessary antibiotic use for viral pharyngitis and prevent complications
of untreated streptococcal infection
What are the complications of pharyngitis?
• Suppurative:
• Peritonsillar abscesses

• Retropharyngeal abscesses,

• Cervical lymphadenitis,

• Otitis media,
• Sinusitis,
• Necrotizing fasciitis
(hemolytic streptococcal gangrene)
What are the complications of pharyngitis?

Non-suppurative:
 Acute rheumatic fever. inflammation in the heart, joints, skin or
CNS..can cause permanent damage to the heart, including damaged
heart valves and heart failure.
 Scarlet fever.
 Streptococcal toxic shock syndrome.(STSS can develop very quickly
into low blood pressure, multiple organ failure, and even death.)
What are the complications of pharyngitis?
 Glomerulonephritis (inflammation and damage to the filtering part of the kidneys
(glomerulus).
no evidence that antibiotic prevent this complication

 Reactive arthritis.(joint pain associated with reactive arthritis, Eye inflammation,

Inflammation of tendons and ligaments, mouth sores and a rash on the soles of the feet and
palms of the hands, Low back pain)
no evidence that antibiotic prevent this complication
• Testing for GAS usually is not recommended for children or adults
with acute pharyngitis with clinical and epidemiological features that
strongly suggest a viral etiology (eg, cough, rhinorrhea, hoarseness,
and oral ulcers).

• Diagnostic studies for GAS are not indicated for children <3 years old
because acute rheumatic fever is rare in children <3 years old and the
incidence of streptococcal pharyngitis and the classic presentation of
streptococcal pharyngitis are uncommon in this age group
TREATMENT

The goals of therapy for streptococcal pharyngitis are to :

• shorten the disease course
• reduce spread,
• and prevent complications
Pharmacologic Therapy
• Pain is a key feature of pharyngitis.
• Oral analgesics provide pain relief and can allow patients to maintain
normal eating and drinking habits.
• Acetaminophen or NSAID
• Acetaminophen better option because NSAIDs may increase
the risk for necrotizing fasciitis/toxic shock syndrome

• Antibiotics should be used only in cases of laboratory-confirmed

Penicillin is the drug of choice because of its narrow spectrum, documented
safety and efficacy in nasopharyngeal streptococcal eradication, and low cost.
Amoxicillin is an alternative agent, particularly for children because of its
improved taste and its enhanced adherence with once-daily dosing.

Cephalosporins may be more effective than penicillin for relapse

prevention and nasopharyngeal eradication, particularly in
asymptomatic carriers.

Usual duration of therapy is 10 days

5-day courses of some cephalosporins are as effective for streptococcal
eradication as 10 days of penicillin.
• Patients with penicillin allergies should be treated with a first-
generation cephalosporin (if non–type I allergy), a macrolide/azalide,
or clindamycin.

• Recurrent infections or treatment failures can be retreated with the

same initial antibiotic or treated with amoxicillin-clavulanate, a first-
generation cephalosporin, clindamycin, or penicillin G benzathine.
Non-pharmacological treatment
• Rest,
• Fluids,
• Lozenges and spray containing menthol and topical anesthetic
• Saltwater gargles
OUTCOME EVALUATION
Antibiotics relieve symptoms of streptococcal pharyngitis within
3 to 5 days, and patients can return to work or school if improved
after the first 24 hours of therapy.

Lack of improvement or worsening after 72 hours of therapy requires

reevaluation.

Follow-up throat cultures are not recommended unless symptoms persist

or recur.
Recurrent symptoms following an appropriate treatment course should
prompt reevaluation for possible retreatment.