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Streptococcal Pharyngitis: Antibiotics Don't Kill Viruses
Pharyngitis, commonly known as a sore throat, can be caused by both bacterial and viral infections. As a clinical emergency medicine pharmacist, it's crucial to distinguish between these causes to ensure appropriate treatment. In this blog post, we'll explore the key differences between bacterial and viral pharyngitis, the importance of accurate diagnosis, and the recommended treatment options.
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Identifying Bacterial Pharyngitis: Group A beta-hemolytic streptococcus is the most common bacterial cause of pharyngitis. When assessing patients with a sore throat, it's essential to look for specific clinical findings such as exudates, erythema, and cobblestoning of the pharyngeal wall. These findings are more consistent with bacterial pharyngitis and may warrant antibiotic treatment.
Understanding Viral Pharyngitis: Viral etiologies are more common than bacterial ones for pharyngitis. It's important to emphasize this fact to avoid the overuse of antibiotics, which can contribute to antimicrobial resistance. Symptoms of viral pharyngitis often include rhinorrhea, cough, oral ulcers, and hoarseness. Since viral pharyngitis is typically self-limiting, antibiotics are not usually necessary and may not be effective in treating the infection.
Diagnostic Tools and Scoring Systems: Various diagnostic tools and scoring systems, such as the Centor criteria, can assist in determining whether the cause of pharyngitis is bacterial or viral. These tools consider factors such as the presence of fever, tonsillar exudates, and swollen lymph nodes. Patients who test positive for Group A Streptococcal diagnostics may benefit from antibiotic treatment.
Treatment Options: For patients with bacterial pharyngitis, antibiotic therapy is typically recommended. Options include:
Penicillin G Benzathine: Intramuscular injection of 600,000 units for patients less than 27 kg and 1.2 million units for those greater than 27 kg.
Oral Penicillin: Tablets of 250-500 mg administered two to four times daily, depending on age and weight.
Amoxicillin: Dosage of 50 mg/kg/day with a maximum of 1000 mg daily for 10 days.
Alternatives for patients with true penicillin allergies include clindamycin, cephalexin, and azithromycin. It's essential to reference local antibiograms to select the most appropriate empiric agent.
Conclusion
In summary, accurate diagnosis is crucial in determining the appropriate treatment for pharyngitis. By understanding the clinical presentations and utilizing diagnostic tools effectively, healthcare providers can differentiate between bacterial and viral causes and avoid unnecessary antibiotic use. As clinical emergency medicine pharmacists, it's our responsibility to promote judicious antibiotic prescribing practices to mitigate antimicrobial resistance and improve patient outcomes.
References
Choby, B. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009 Mar 1;79(5):383-90.
Luo et al. Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011-2015. BMC Infect Dis. 2019 Feb 26;19(1):193.doi: 10.1186/s12879-019-3835-4.
Mustafa Z, Ghaffari M. Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review. Front Cell Infect Microbiol. 2020; 10: 563627.
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