Pharyngitis - Revision history

Danbot: Strip excess bold

2026-03-22T09:32:35Z

Strip excess bold

Danbot: Move calculators to own section with header (visible in TOC), expanded, before External Links

2026-03-21T15:07:28Z

Move calculators to own section with header (visible in TOC), expanded, before External Links

← Older revision		Revision as of 15:07, 21 March 2026
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	*Consider acute HIV in any patient with a mononucleosis-like illness and negative Monospot		*Consider acute HIV in any patient with a mononucleosis-like illness and negative Monospot
	*Always assess for ability to tolerate PO fluids before discharging pharyngitis patients, particularly young children		*Always assess for ability to tolerate PO fluids before discharging pharyngitis patients, particularly young children

			== Calculators ==
			{{Centor_Calculator}}

	==See Also==		==See Also==
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	==References==		==References==
	{{reflist\|2}}		{{reflist\|2}}


	~~<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">~~
	~~<div style="font-weight:bold;">📊 Centor/McIsaac Score Calculator [show]</div>~~
	~~<div class="mw-collapsible-content">~~
	~~{{Centor_Calculator}}~~
	~~</div>~~
	~~</div>~~
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:ENT]]		[[Category:ENT]]
	[[Category:ID]]		[[Category:ID]]

Danbot: Add Centor/McIsaac Score calculator (collapsible)

2026-03-21T13:44:15Z

Add Centor/McIsaac Score calculator (collapsible)

← Older revision		Revision as of 13:44, 21 March 2026
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	{{reflist\|2}}		{{reflist\|2}}


			<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">
			<div style="font-weight:bold;">📊 Centor/McIsaac Score Calculator [show]</div>
			<div class="mw-collapsible-content">
			{{Centor_Calculator}}
			</div>
			</div>
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:ENT]]		[[Category:ENT]]
	[[Category:ID]]		[[Category:ID]]

Ostermayer at 00:17, 1 March 2026

2026-03-01T00:17:28Z

Show changes

Rossdonaldson1: /* Clinical Features */

2021-11-03T22:02:41Z

Clinical Features

← Older revision		Revision as of 22:02, 3 November 2021
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	==Clinical Features==		==Clinical Features==
			[[File:Pharyngitis.jpg\|thumb\|Generalized erythema of the pharnyx, consistent with pharyngitis.]]
	[[File:Pos strep.jpg\|thumb\|culture positive strep pharyngitis with typical tonsillar exudate]]		[[File:Pos strep.jpg\|thumb\|culture positive strep pharyngitis with typical tonsillar exudate]]
	*[[Sore throat]]		*[[Sore throat]]

Rossdonaldson1: /* Background */

2021-03-18T15:49:11Z

Background

← Older revision		Revision as of 15:49, 18 March 2021
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	==Background==		==Background==
			[[File:Gray1014.png\|thumb\|Anatomy of the posterior pharynx.]]
	*2% of all ED visits		*2% of all ED visits
	*Viral is most common		*Viral is most common

ClaireLewis: /* References */

2019-10-06T19:55:04Z

References

← Older revision		Revision as of 19:55, 6 October 2019
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	[[Category:ENT]]		[[Category:ENT]]
	[[Category:ID]]		[[Category:ID]]
			[[Category:Symptoms]]

ClaireLewis at 22:32, 30 September 2019

2019-09-30T22:32:07Z

← Older revision		Revision as of 22:32, 30 September 2019
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	*[[Nausea and vomiting]]		*[[Nausea and vomiting]]
	*Tonsillar exudate		*Tonsillar exudate
	*Palatal petechiae		*Palatal [[petechiae]]
	*If ~~s/p~~ treatment for bacterial pharyngitis ~~w/ amox~~ or ampicillin and develop pruritic maculopapular rash, this is classic for EBV pharyngitis		*If status post treatment for bacterial pharyngitis with [[amoxicillin]] or [[ampicillin]] and develop pruritic maculopapular [[rash]], this is classic for [[EBV]] pharyngitis

	{{Modified Centor Criteria}}		{{Modified Centor Criteria}}

			==Complications==
			*[[Acute rheumatic fever]]
			*[[Scarlet fever]]
			*[[Toxic shock syndrome]]
			*[[Post-streptococcal glomerular nephritis]]
			*[[Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS)]]
			*[[Peritonsillar abscess]]
			*Cervical [[lymphadenitis]]
			*[[Mastoiditis]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Disposition==		==Disposition==
	*Discharge		*Discharge

	~~==Complications==~~
	*[[Acute rheumatic fever]]
	*[[Scarlet fever]]
	*[[Toxic shock syndrome]]
	*[[Post-streptococcal glomerular nephritis]]
	*[[Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS)]]
	*[[Peritonsillar abscess]]
	*Cervical lymphadenitis
	*[[Mastoiditis]]

	==See Also==		==See Also==

ElavemanMD: /* Steroids */

2019-09-11T17:58:33Z

Steroids

← Older revision		Revision as of 17:58, 11 September 2019
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	===[[Steroids]]===		===[[Steroids]]===
	*~~Consider~~ single dose of [[dexamethasone]] 0.6mg/kg PO (Max = 10mg)<ref>[[EBQ:TOAST Trial]]</ref>		*In adults consider single dose of [[dexamethasone]] 0.6mg/kg PO (Max = 10mg)<ref>[[EBQ:TOAST Trial]]</ref>
			*In children consider single dose of [[dexamethasone]] 0.6mg/kg PO (Max = 10mg)<ref>Olympia, R. P. (2003). The Effectiveness of Oral Dexamethasone in the Treatment of Moderate to Severe Pharyngitis in Children and Young Adults. Academic Emergency Medicine, 10(5). doi: 10.1197/aemj.10.5.434-a </ref>

	==Disposition==		==Disposition==

Gheid: /* Clinical Features */

2019-06-23T14:10:55Z

Clinical Features

← Older revision		Revision as of 14:10, 23 June 2019
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	*Tonsillar exudate		*Tonsillar exudate
	*Palatal petechiae		*Palatal petechiae
			*If s/p treatment for bacterial pharyngitis w/ amox or ampicillin and develop pruritic maculopapular rash, this is classic for EBV pharyngitis

	{{Modified Centor Criteria}}		{{Modified Centor Criteria}}

← Older revision		Revision as of 09:32, 22 March 2026
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	===Key Evaluation Principles===		===Key Evaluation Principles===
	*Do ~~'''~~not~~'''~~ test patients with clear viral features ([[cough]], [[rhinorrhea]], hoarseness, oral ulcers, [[conjunctivitis]]) — treat supportively<ref name="idsa2012"/><ref name="idsa2025"/>		*Do not test patients with clear viral features ([[cough]], [[rhinorrhea]], hoarseness, oral ulcers, [[conjunctivitis]]) — treat supportively<ref name="idsa2012"/><ref name="idsa2025"/>
	*Do ~~'''~~not~~'''~~ routinely test children <3 years of age (both GAS and [[acute rheumatic fever]] are rare), unless risk factors (e.g., sibling with GAS)<ref name="idsa2012"/>		*Do not routinely test children <3 years of age (both GAS and [[acute rheumatic fever]] are rare), unless risk factors (e.g., sibling with GAS)<ref name="idsa2012"/>
	*The 2025 IDSA guideline update recommends using a standardized clinical scoring system (e.g., Modified Centor/McIsaac) to identify low-risk patients who do not need testing<ref name="idsa2025"/>		*The 2025 IDSA guideline update recommends using a standardized clinical scoring system (e.g., Modified Centor/McIsaac) to identify low-risk patients who do not need testing<ref name="idsa2025"/>
	*For those meeting testing criteria: use Rapid Antigen Detection Test (RADT)		*For those meeting testing criteria: use Rapid Antigen Detection Test (RADT)
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	*Centor/McIsaac score of 0-1: do not test, treat symptomatically		*Centor/McIsaac score of 0-1: do not test, treat symptomatically
	*Centor/McIsaac score of ≥2: test with RADT (± backup culture in children)		*Centor/McIsaac score of ≥2: test with RADT (± backup culture in children)
	*Do ~~'''~~not~~'''~~ test asymptomatic contacts routinely<ref name="idsa2012"/>		*Do not test asymptomatic contacts routinely<ref name="idsa2012"/>
	*Do ~~'''~~not~~'''~~ perform test of cure after treatment unless history of [[acute rheumatic fever]] or recurrent GAS complications<ref name="idsa2012"/>		*Do not perform test of cure after treatment unless history of [[acute rheumatic fever]] or recurrent GAS complications<ref name="idsa2012"/>

	===Additional Testing to Consider (When Clinically Indicated)===		===Additional Testing to Consider (When Clinically Indicated)===
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	==Management==		==Management==
	===Symptomatic Treatment===		===Symptomatic Treatment===
	*~~'''~~Analgesics/antipyretics~~'''~~ are the foundation of treatment for ALL pharyngitis (viral and bacterial)		*Analgesics/antipyretics are the foundation of treatment for ALL pharyngitis (viral and bacterial)
	**[[Ibuprofen]] 400-600mg PO q6h PRN (adults); 10 mg/kg PO q6h PRN (pediatric)		**[[Ibuprofen]] 400-600mg PO q6h PRN (adults); 10 mg/kg PO q6h PRN (pediatric)
	**[[Acetaminophen]] 1000mg PO q6h PRN (adults); 15 mg/kg PO q4-6h PRN (pediatric)		**[[Acetaminophen]] 1000mg PO q6h PRN (adults); 15 mg/kg PO q4-6h PRN (pediatric)
	**Ibuprofen may be slightly more effective for throat pain than acetaminophen<ref name="mahp"/>		**Ibuprofen may be slightly more effective for throat pain than acetaminophen<ref name="mahp"/>
	**Avoid [[aspirin]] in children ([[Reye syndrome]])		**Avoid [[aspirin]] in children ([[Reye syndrome]])
	*~~'''~~Topical therapies:~~'''~~		*Topical therapies:
	**Salt water gargle		**Salt water gargle
	**Viscous [[lidocaine]] (adults) — use with caution due to aspiration risk		**Viscous [[lidocaine]] (adults) — use with caution due to aspiration risk
	**Consider "magic mouthwash" ([[diphenhydramine]]/[[lidocaine]]/antacid mixture)		**Consider "magic mouthwash" ([[diphenhydramine]]/[[lidocaine]]/antacid mixture)
	*~~'''~~Hydration:~~'''~~ encourage oral fluids, soft diet; assess ability to tolerate PO before discharge		*Hydration: encourage oral fluids, soft diet; assess ability to tolerate PO before discharge

	===[[Antibiotics]]===		===[[Antibiotics]]===
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	*Treatment is indicated for laboratory-confirmed GAS pharyngitis (RADT or culture positive)<ref name="idsa2012"/>		*Treatment is indicated for laboratory-confirmed GAS pharyngitis (RADT or culture positive)<ref name="idsa2012"/>
	*'''Do not''' treat empirically based on clinical features alone in most cases<ref name="idsa2025"/>		*'''Do not''' treat empirically based on clinical features alone in most cases<ref name="idsa2025"/>
	*~~'''~~Goal:~~'''~~ prevent [[acute rheumatic fever]], reduce suppurative complications, improve symptoms, decrease transmission		*Goal: prevent [[acute rheumatic fever]], reduce suppurative complications, improve symptoms, decrease transmission
	*~~'''~~Key point:~~'''~~ antibiotics shorten symptom duration by approximately 1-2 days when started early<ref name="spinks">Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021;12:CD000023.</ref>		*Key point: antibiotics shorten symptom duration by approximately 1-2 days when started early<ref name="spinks">Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021;12:CD000023.</ref>

	===[[Steroids]]===		===[[Steroids]]===
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	*Discharge home with symptomatic treatment ± antibiotics		*Discharge home with symptomatic treatment ± antibiotics
	*Patient can return to work/school after ≥24 hours of antibiotic therapy and clinical improvement (for confirmed GAS)<ref name="cdc">CDC. Clinical Guidance for Group A Streptococcal Pharyngitis. Centers for Disease Control and Prevention. Updated November 2025. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>		*Patient can return to work/school after ≥24 hours of antibiotic therapy and clinical improvement (for confirmed GAS)<ref name="cdc">CDC. Clinical Guidance for Group A Streptococcal Pharyngitis. Centers for Disease Control and Prevention. Updated November 2025. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>
	*~~'''~~Return precautions:~~'''~~		*Return precautions:
	**Unable to tolerate oral fluids		**Unable to tolerate oral fluids
	**Worsening sore throat or new difficulty swallowing despite treatment		**Worsening sore throat or new difficulty swallowing despite treatment