Streptococcal pharyngitis is a throat infection by group A Streptococcus, most common in children 5 to 15 years old. Antibiotics shorten symptoms and prevent complications such as rheumatic fever and peritonsillar abscess.
Key symptoms
- Sudden sore throat and painful swallowing
- Fever
- Headache, abdominal pain and nausea, mostly in children
- No cough and no runny nose
- Fine sandpaper rash in scarlet fever
What you find on exam
- Red, swollen tonsils with exudate
- Tender, swollen front neck lymph nodes
- Petechiae on the soft palate
- Strawberry tongue in some cases
- Trismus or uvula deviation that suggests an abscess
Tests
- Centor or McIsaac score to decide who needs testing
- Rapid antigen detection test
- Throat culture if the rapid test is negative in children and teens
- No testing when symptoms are clearly viral
Treatment basics
- Oral amoxicillin or penicillin V for 10 days, or one IM dose of benzathine penicillin G
- Penicillin allergy: cephalexin, or azithromycin or clindamycin if the allergy is severe
- Ibuprofen or acetaminophen for pain and fever
- Back to school after 12 hours of antibiotics and no fever
Red flags
- Drooling, muffled voice or trismus
- Stridor or trouble breathing
- Joint pain, chest pain or dark urine weeks later
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.