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

  • Weglowski, Jennifer MD, FAAP
  • Caglar, Derya MD
  • Sharieff, Ghazala Q. MD, FAAP, FACEP, FAAEM
  • Whiteman, Paula MD

  • Authors

    1Assistant Professor of Pediatrics, University of California San Diego; Attending Physician, Division of Pediatric Emergency Medicine, Rady Children's Hospital, San Diego, CA

    Peer Reviewers

    2Assistant Professor of Pediatrics, University of Washington; Attending Physician, Division of Emergency Medicine Seattle Children's Hospital, Seattle, WA

    3Associate Clinical Professor, Children's Hospital and Health Center/University of California; Director of Pediatric Emergency Medicine, California Emergency Physicians, San Diego, CA

    4Medical Director, Pediatric Emergency Medicine, Encino- Tarzana Regional Medical Center, Tarzana, CA; Attending Physician, Cedars-Sinai Medical Center, Los Angeles, CA

Pediatric Emergency Medicine Practice 8(12):p 1-25, November 2011.

Abstract

Sore throat is a very common complaint, accounting for approximately 7.3 million outpatient physician visits each year among children in the United States. Group A streptococcus (GAS) is the most common bacterial cause of sore throat and is responsible for 15% to 36% of cases. Estimated total costs attributable to GAS pharyngitis in children and adolescents are $224 million to $539 million annually, with most of these costs being attributed to parents' lost work time. Pharyngitis is generally a straightforward and self-limited complaint. However, the emergency clinician must appreciate that sore throat can occasionally be a symptom of a much more serious or potentially life-threatening condition.

Case Presentation

It is another busy weekend night in the ED. The next patient waiting to be seen has a chief complaint of “sore throat and fever for 5 days. “ You enter the room and find a mother and her 11-year-old son. He is ill-appearing and pale but nontoxic and in no respiratory distress. His mother explains that she took the child to his usual doctor 3 days ago for evaluation of fever, sore throat, and generalized abdominal pain. A rapid strep test was done and was “negative” per the mother's report. Results of a throat culture are pending, but since the doctor's office is closed for the weekend, she does not yet have them. She is very concerned because the child continues to complain of severe sore throat and is running fevers as high as 39°C (102°F). She says, “Doctor, I hope you can help us. I should have insisted that he be prescribed antibiotics while we waited for the throat culture results to come back. He's just not getting any better!” On examination, you observe enlarged, injected tonsils with a significant amount of white exudate; enlargement of the posterior cervical lymph nodes; and a mildly tender abdomen. You remember the natural history of streptococcal pharyngitis and reply, “I don't think that an antibiotic would have helped very much in this situation. I recommend doing some laboratory tests to confirm my suspicion.”

CME Objectives

Upon completion of this article, you should be able to:

  1. Cite the life-threatening causes of pharyngitis and how they may present.

  2. Cite the differences in the etiologies of pharyngitis among young children versus adolescents.

  3. Apply the currently recommended clinical scoring systems and testing strategies for GAS pharyngitis and evaluate how they differ when applied to young children versus adolescents.

  4. Cite the appropriate treatment for GAS pharyngitis, including antibiotic therapy and supportive care.

Prior to beginning this activity, see the back page for Physician CME Information.

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