Acute tonsillopharyngitis - An evidence-based approach

Abstract

Objectives: to review the diagnostic methodology of acute Streptococcal pharyngitis (ASP), and the therapeutic recommendations for its treatment. Methods: Medline, online and hand search for articles published in medical journals in the last five years. Key-words used: sore throat, pharyngitis, tonsillitis, management, diagnosis, treatment, antibiotics. Conclusions: Clinical characteristics when used in isolation do not allow for an adequate distinction between Strep throat and other agents. Clinical scores increase diagnostic acuity by identifying groups of patients at low risk for infection, and by raising diagnostic sensitivity in children, a group in whom rheumatic fever is more frequent. Most authors propose that before starting an antibiotic, one should first test for the presence of pharyngeal group A Strep with either culture or a rapid antigen detection test. They suggest that antibiotic therapy could be started empyrically whenever a maximum clinical score is obtained. A single intramuscular dose of penicillin G benzatine still is the first-line treatment for ASP. Only in allergic patients should erythromycin be used. Alternatives to first-line treatment, especially for recurrent ASP, could include (in decreasing order of preference): amoxicillin (isolated, or in association with clavulanate), first-generation cephalosporins, and newer macrolides.