Pharyngitis: Treat Only Proven GAS: Physician Information Sheet (Pediatrics)

Careful Antibiotic Use

To avoid antibiotic resistance: treat only proven group A strep

Print-friendly version of this academic detailing sheet (80 KB, 1 page)

Pharyngitis in Children¹

• Most sore throats are caused by viral agents.²

  

• Clinical findings alone do not adequately distinguish Strep vs. Non-Strep pharyngitis.³

  BUT, prominent rhinorrhea, cough, hoarseness, conjuntivitis, or diarrhea suggest a VIRAL etiology. ⁴

• Antigen tests (rapid Strep kits) or culture should be positive before beginning antibiotic treatment.

  Experts suggest confirming negative results on antigen tests with culture.⁵

Remember that most cases with clinical signs of strep, like exudate and adenopathy, are viral.

• Experts discourage treatment pending culture results^5-6, but if you do...
  • Make sure to stop antibiotics when culture is negative.
  • Discourage parents from saving antibiotics.

• If an antibiotic is prescribed:
  • Use a penicillin as treatment for group A strep.⁷
  • NO group A strep are resistant to penicillin. Treatment is 90% effective at elimination of strep, and may be higher in the prevention of acute rheumatic fever (ARF). Carriers are at very low risk for both ARF and spreading infection.⁷
  • Use erythromycin if penicillin allergic.

References

1. Schwartz B, Marcy SM, Phillips WR, Gerber MA, Dowell SF, Pharyngitis-principles of judicious use of antimicrobial agents. Pediatrics 1998;101:171-174
2. Tanz RR, Shulman ST. Diagnosis and treatment of group A streptococcal pharyngitis. Semin Pediatr Infect Dis 1995;6:69-78.
3. Poses RM, Cebul RD, Collins M, et al. The accuracy of experienced physicians’ probability estimates for patients with sore throat: implications for decision making. JAMA 1985;254:925-29.
4. Denson MR. Viral pharyngitis. Semin Pediatr Infect Dis 1995;6:62-68.
5. American Academy of Pediatrics. Group A streptococcal infections. In: Pickering LK, ed. 2000 Red Book: Report of the Committee on infectious Diseases. 25th ed. Elk Grove, IL: American Academy of Pediatrics; 2000:528.
6. Middleton DB, D’ Amico FD, Merenstein JH. Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis. J Pediatr 1988;113:1089-94.
7. Shulman ST, Gerber MA, Tanz RR, Markowitz M. Streptococcal pharyngitis: the case for penicillin therapy. Pediatr Infect Dis J 1994;13:1-7.