An Evidence-Based Approach To The Evaluation And Treatment Of Pharyngitis In Children

King, Brent R. MD, FAAP, FACEP, FAAEM
Toscano, Joseph MD
Whiteman, Paula J. MD, FACEP

¹Author
²Professor of Emergency Medicine and Pediatrics; Chairman, Department of Emergency Medicine, The University of Texas Medical School at Houston, TX
³Peer Reviewers
⁴Emergency Physician, San Ramon, CA
⁵Medical Director, Pediatric Emergency Medicine, Encino-Tarzana Regional Medical Center; Attending Physician, Cedars-Sinai Medical Center, Los Angeles, CA

Date of original release: June 1, 2007.

Date of most recent review: April 5, 2007.

See “Physician CME Information” on back page.

Pediatric Emergency Medicine Practice 4(6):p 1-28, June 2007.

You are somewhat puzzled as you enter the examination room. The chart in your hand has a chief complaint of “strep throat, not getting better,” which is, in your experience, unusual.

In the room, you find a mother and her adolescent daughter. The girl looks tired and pale, but not seriously ill. Her mother looks at you and, with near-desperation in her voice, says, “I hope you can help us, Doctor. My daughter has been to our regular doctor twice and to another emergency room. She is on her third different antibiotic but her throat is still sore and she sometimes has trouble swallowing. This afternoon she really scared me because she said she was having trouble breathing!”

When you examine the girl's throat, you see very swollen tonsils coated with exudates. You are momentarily confused but then remember something from way back in residency. You look at the mother and say, “Ma'am, I think I know what's wrong but I need to do a blood test to be sure.”