Acute Pharyngitis in Children part II

Treatment

MC ISAAC SCORE
Criteria (1 point for clinical sign found)
Original Criteria
1. Enlarged tonsil or exudate
2. Anterior cervical soft Adenopati
3. No cough
4. Temperature > 38 ° C

Modification
1. Age 3-14 years: +1 point
2. Age 15-44 years: 0 point
3. Age > 45 years: -1 point

Interpretation (Clinic and ER probability) Based original criteria:
Score 0: Probability Streptococcus 1%
Score 1: Probability Streptococcus 4%
Score 3: Probability Streptococcus 21%
Score 4: Probability Streptococcus 43%

Approach: Clinical Suspicion based on Strep Score
Score 4 (Score 2 if patient or unreliable): treatment with antibiotics
Score 2 and 3: do rapid antigent test
if antigent test is positive: treatment with antibiotics
if antigent test is negative: culture
Score 0 and 1: symptomatic Pharyngitis therapy

If Streptococcal pharyngitis is suspected, give:
Oral: penicilin V 250 mg 2 or 3 times perday during 10 days
IM : Benxathin penicillin: <> 27 kg: 1,2 million units x 1 dose
For patients with allergic of peniciliin
estolate Erytromycin: 20-40 mg/Kg/day 2-4 times (max 1 g/day) for 10 days
Eritromycin ethylsuccinate 40 mg/Kg/day 2-4 times (max 1 g/day) for 10 days
For patients with allergic penicillin and erytromycin
Clindamycin: 20-30 mg/kg/day, 3 times over 10 days

The recurrent streptococcal pharyngitis with antibiotic therapy may be caused by inappriate antibiotic therapy (eg, cotrimoxazole), inadequate dose or duration of therapy, and the organisms that produce beta-lactamase.

Sopportive
Rest and adequate provision of appropiate fluid
Provision of mouthwash (gargles) and drug suction (lozenges), in big children can relieve throat pain
if there are pain and fever, can use paracetamol or ibuprofen