59 - Pharyngitis

Abstract

Acute pharyngitis is typically described as the triad of sore throat, fever, and pharyngeal inflammation primarily characterized by erythema and edema. Although pharyngitis may be a primary disorder, sore throat and pharyngeal erythema may also be prominent in systemic disorders, such as the acute retroviral syndrome or Epstein-Barr virus infection, or part of a more generalized upper respiratory tract infection. Most cases of acute pharyngitis are due to common viral infections and are benign, self-limited processes. Streptococcus pyogenes, group A Streptococcus (GAS), is the bacterial etiology of greatest concern in cases of acute pharyngitis because of the association between GAS and suppurative and nonsuppurative complications of infection, including acute rheumatic fever. As pharyngitis is one of the most common complaints a physician may encounter, diagnosis of treatable etiologies is a primary goal of medical care. In a patient with signs and symptoms suggestive of pharyngitis due to GAS, rapid antigen detection tests and/or throat culture are the preferred methods of diagnosis. A 10-day course of penicillin or amoxicillin is the treatment of choice and is recommended by the Infectious Diseases Society of America and American Academy of Pediatrics for the treatment of pharyngitis caused by GAS. Penicillin-allergic patients should be given a macrolide (erythromycin) or first-generation cephalosporin for non–immunoglobulin E–mediated allergy.