Pharyngitis

Question 1

Define Pharyngitis

Answer 1

Inflammation in the back of the throat

Question 2

What are some causes of sore throat?

Answer 2

Allergies
Meds
Irritating substances
Trauma
Tumour
Infection

Question 3

What biggest cause of pharyngitis?

Answer 3

A virus (rhinovirus)

Question 4

What are the top three virus that causes pharyngitis?

Answer 4

Rhinovirus
Coronavirus
Influenza

Question 5

Viral Causes of Acute Pharyngitis

Answer 5

Rhinovirus
Adenovirus
Herpes
Parainfluenza
Coxsackie
Epstein Barr
Influenza A and B
Cytomegalovirus
HIV

Question 6

What percentage of pharyngitis caused by virus?
Adult and children

Answer 6

80-90 adults
70 children

Question 7

What percentage of pharyngitis caused by bacteria?
Adult and children

Answer 7

5-15% adult
15-30% sore throats

Question 8

What amount of adult pt with acute pharyngitis are prescribed?

Answer 8

75%

Question 9

Why the overuse of antibiotics?

Answer 9

Pt expect them
Pt will see other MD
Pt will not be satisfied without prescription
Quicker to write than explain

Question 10

Epidemiology of Pharyngitis

Answer 10

Most cases occur during the colder months
Viral usually peak in fall to spring
Strep throat also peaks
Spread within close contacts

Question 11

What is group A strep?

Answer 11

The only commonly occurring cause of sore throat that antibiotics are indicated

Question 12

What is the signs and symptoms of Group A?

Answer 12

All cause may have similar
Painful swallowing, exudates, enlarged anterior cervical lymph nodes, fever, increased WBCs, N & V and rash

Question 13

What is scarlatiniform rash?

Answer 13

It feels like sand paper
Small red bumps

Question 14

What is the scoring system?

Answer 14

Centro score

Question 15

What is measured in Centro score?

Answer 15

Age
Exudate/swelling tonsils
Swollen cervical nodes
Temp > 38
No cough

Question 16

Interpretation of Score

Answer 16

1,0, -1 symptomatic treatment
No RADT, culture
>2 RADT or throat swab for culture
If positive give antibiotics

Question 17

Ways to diagnosis of GAS pharyngitis

Answer 17

Culture
RADT

Question 18

Explain details of culture test

Answer 18

Gold standard
>90% sensitivity
May take 1-2 days to get results

Question 19

Explain the RADT for diagnosis

Answer 19

Takes minutes
+ test = strep throat
Only 70-90% sensitivity

Question 20

Reasons to Treat

Answer 20

Decrease severity and duration of symptoms
Reduce risk of transmission to others
Reduce complications
Prevent rheumatic heart disease

Question 21

What is RHD?

Answer 21

Rheumatic heart disease
Heart valve damage (inflammatory response)

Question 22

What antibiotic can prevent RHD?

Answer 22

Penicillin treatment

Question 23

What the goal standard for GAP treatment?

Answer 23

Penicillin V

Question 24

What is the dose and duration for adults and children?

Answer 24

Adults 300 mg TID or 600 mg BID
Ped 40mg/kg/day BID or TID
Duration is 10 days
(Need to be all 10 day)

Question 25

Benefits of penicillin V

Answer 25

Narrow spectrum of activity Effective, safe, and cheap

Question 26

GAS treatment for penicillin allergies

Answer 26

Erythromycin Ethylksuccinate Estolate Clarithromycin Azithromycin

Question 27

What is the dose for Eryc?

Answer 27

Dose of 250-500 mg BID to QID 10 days

Question 28

What is the dose for ethylsuccinate?

Answer 28

40 mg/kg/day given BID to QID For 10 days

Question 29

What is the dose for Estolate

Answer 29

40 mg/kg/day given BID to QID For 10 days

Question 30

Could you give less days and still have the same effectiveness?

Answer 30

No needs to be all 10 days

Question 31

What is the dose of clarithromycin?

Answer 31

15 mg/kg/day given BID for 5 days

Question 32

What dose of azithromycin?

Answer 32

12 mg/kg daily x 5 days

Question 33

What is the dose for amoxicillin? (adult and children)

Answer 33

Adult 500 mg BID Peds 40-50 mg/kg/day given daily or BID For 10 days

Question 34

Antibiotics used as second line or treatment failures

Answer 34

Cephalosporins (1st / 2nd gen) Clindamycin Intramuscular penicillin

Question 35

Do we treat non-symptomatic pt?

Answer 35

No It does not need to be treated

Question 36

What is some examples of symptomatic treatment?

Answer 36

Oral analgesics Topical analgesics Lozenges Gargling with salt water Fluids Rest

Question 37

How long will it take to be non contagious?

Answer 37

24 hours after taking antibiotics

Question 38

How long should kids stay at home?

Answer 38

24 hours after starting antibiotics and have no fever

Question 39

What is our Roles?

Answer 39

Make sure an antibiotic is warranted If Rx for antibiotic is needed

Question 40

What to do to make sure an antibiotic is warranted?

Answer 40

Educate if not needed - refer if required Symptomatic treatment

Question 41

What to do if Rx for antibiotic is needed?

Answer 41

Ensure proper drug, dose, and duration Counsel pt on the benefits of the drugs Make pt aware of meaningful side effects Let pt. Know what to expect

Question 42

Take aways from pharyngitis

Answer 42

Most sore throats will never need antibiotics If a pt does have strep throat Antibiotics are warranted Need to educated pt Proper drug, dose, and duration need to be used