Makindo Medical Notes

Introduction

• Common causes of a sore throat include infections that can be viral or bacterial.

Aetiology

• Viral: Rhinovirus, adenovirus (most common causes).
• Bacterial: Group A Streptococcus (GAS) is the most common bacterial cause.

Clinical Features

• Symptoms: Odynophagia (painful swallowing), upper respiratory tract symptoms (e.g., runny nose, cough).
• Complications are rare but can include conditions like rheumatic fever and glomerulonephritis.
• Physical Exam: Check vital signs, assess ABCs (Airway, Breathing, Circulation), and evaluate for red flags (e.g., signs of airway obstruction).

Important Differentials

• Peritonsillar Abscess: Presents with a muffled "hot potato" voice, uvular deviation, and unilateral tonsillar swelling.
• Retropharyngeal Abscess: Features include drooling, difficulty swallowing, and potential airway compromise. May occur more commonly in children.
• Tracheitis: Can be confused with croup. Symptoms include stridor and laboured breathing.
• Epiglottitis: Features include fever, stridor, and rapid progression of airway swelling. This is a medical emergency.

Management

• Supportive Care: Hydration, antipyretics (e.g., paracetamol/acetaminophen, ibuprofen), and a single dose of dexamethasone may reduce pain and duration of symptoms.
• Antibiotics: Can reduce symptoms by approximately 16 hours. However, antibiotics do not significantly reduce the incidence of suppurative complications like abscesses.

Antibiotic Management

• To guide antibiotic use, the CENTOR score is used:
• Tonsillar exudate: +1
• Tender anterior cervical lymph nodes: +1
• Absence of cough: +1
• History of fever >38°C: +1
• Age: 3-14 years: +1, 15-44 years: +0, ≥45 years: -1

A CENTOR score of 3 or 4 suggests that the patient may benefit from antibiotics. A score of less than 3 suggests an 80% chance that the patient does not have a bacterial infection, and antibiotics are likely unnecessary. However, this score should only serve as a guide, as it may lead to some bacterial pharyngitis cases not being treated, while others might receive unnecessary antibiotics.

Choice

• First-choice oral antibiotic: Phenoxymethylpenicillin: 500 mg four times a day or 1,000 mg twice a day for 5 to 10 days.
• Penicillin allergy or intolerance (for people who are not pregnant). Clarithromycin: 250 mg to 500 mg twice a day for 5 days
• Penicillin allergy in pregnancy: Erythromycin: 250 mg to 500 mg four times a day or 500 mg to 1,000 mg twice a day for 5 days