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Streptococcal Pharyngitis

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Key Points ����Group A ��-hemolytic streptococcus (GAS) is the most common bacterial cause of acute pharyngitis, responsible for 5%-15% of sore throat visits in adults and 20%-30% in children. ����Although acute pharyngitis is one of the most frequent illnesses for which pediatricians and other primary care physicians are consulted, with an estimated 15 million visits per year in the U.S., only a relatively small percentage of patients with acute pharyngitis (20%-30% in children, fewer in adults) are infected by GAS pharyngitis. ����Moreover, the signs and symptoms of GAS and nonstreptococcal pharyngitis overlap so broadly that accurate diagnosis on clinical grounds alone is usually impossible. ����Accurate diagnosis of streptococcal pharyngitis followed by appropriate antimicrobial therapy is important: ������ to prevent acute rheumatic fever with and without carditis ������ to prevent suppurative complications (e.g., peritonsillar abscess, cervical lymphadenitis, mastoiditis and possibly other invasive infections) ������ to improve clinical symptoms and signs ������ for rapid decrease in contagiousness ������ to reduce transmission of GAS to family members, classmates, and other close contacts of the patient ������ to allow for the rapid resumption of usual activities ������ to minimize potential adverse effects of inappropriate antimicrobial therapy. ����Penicillin or amoxicillin remains the treatment of choice, and azithromycin, clarithromycin, clindamycin or a 1st generation cephalosporin a for the penicillin-allergic patient. ����With the exception of very rare infections by certain other bacterial pharyngeal pathogens (e.g., Corynebacterium diphtheriae and Neisseria gonorrhoeae) (Table 2), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to organisms other than Group A streptococci. Therefore, it is extremely important that physicians confirm the diagnosis of GAS pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with non-streptococcal pharyngitis. a Unless reaction to a penicillin was anaphylactic.

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