Management of Common Infections

Bacterial Causes

Viral Causes

Pharyngitis

· Group A Streptococcal pharyngitis is clinically indistinguishable from viral pharyngitis

Signs and Symptoms influenza

Diagnosis of Group A Streptococcus

· Rapid antigen tests

· Culture

· Antibody response

Reasons for Treating Group A Streptococcal Pharyngitis

· Prevention of complications

- Prevention of Rheumatic fever

- Prevention of Suppurative complications

- Possibly prevention of toxic shock

· Amelioration of symptoms

· Reduced transmission

Treatment of GAS Pharyngitis

· Penicillin is still drug of choice; it may be given every 12 hours.

· Regardless of therapy, there will be a 10% failure rate.

· No isolates have been resistant to penicillin.

Causes of Penicillin Failure

· Noncompliance

· Beta-lactamase production

· Reinfection

· Carrier state

· Decreased immunologic response

· Tolerance

Antibiotic Alternatives

· Cephalosporins

· Amoxicillin-Clavulanate

· Macrolides

· Clindamycin

· Ineffective Antibiotics: Trimethoprim/sulfamethoxazole and tetracyclines

Treatment of GAS Pharyngitis

· Despite any therapy there will be a 10% failure rate

· Retreat if symptomatic with positive culture

· Return to school: 24 hours after starting antibiotics

· Re-culture is not recommended if the patient is asymptomatic

Group A Streptococcus Carrier State

· Carriers are culture positive, but not symptomatic.

· Group A streptococcus infection can not be distinguished from a viral infection occurring in a GAS carrier.

· The risk of rheumatic fever is not increased.

· The risk of suppurative complications is not increased.

· The incidence of transmission is low.

Group A Streptococcus Carriers

· Screening for carriers is initiated only in the following situations:

· An influenza outbreak