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Wednesday, September 19, 2012

Recent Guidelines to Treat Sore Throat

Posted by Dr Prahallad Panda on 6:05 PM Comments

Acute pharyngitis or sore throat is a very common condition, generally seen in the Winter months or early Spring. Commonly, some antibiotics are prescribed by doctors, which may not be useful; rather harmful because most of the sore throat are caused by viruses.

English: Streptococcal pharyngitis
English: Streptococcal pharyngitis (Photo credit: Wikipedia)
However, it is not that easy differentiate between the viral sore throat and bacterial sore throat. There are several bacteria which can cause throat infection, but most common bacterium is group A streptococci (GAS). 
The characteristics of GAS is that the disorder is primarily a disease of children 5–15 years of age, and, in temperate climates, it usually occurs in the winter and early spring. Patients with GAS pharyngitis commonly present with sore throat (generally of sudden onset), pain on swallowing, and fever. Headache, nausea, vomiting, and abdominal pain may also be present, especially in children.
On examination, patients have tonsillopharyngeal erythema, with or without exudate, often with tender, enlarged anterior cervical lymph nodes (lymphadenitis). Other findings may include a beefy, red, swollen uvula; petechiae on the palate; excoriated nares (especially in infants); and a scarlatiniform rash. 
Conversely, the absence of fever or the presence of clinical features such as conjunctivitis, cough, hoarseness, coryza, anterior stomatitis, discrete intra-oral ulcerative lesions, viral exanthema, and diarrhea strongly suggest a viral rather than a streptococcal aetiology.
Wherever indicated a Rapid Antigen Detection Test (RADT) can be used to detect a streptococcal pharyngitis. That may be supported by conventional throat swab and culture to identify bacteria actually responsible for infection. This is important because in children the GAS infection may lead to carditis and rheumatic fever in later age; which my end in rheumatic heart diseases.
Viruses are the most common cause of acute pharyngitis.  Most common viruses are respiratory viruses, such as adenovirus, influenza virus, parainfluenza virus, rhinovirus, and respiratory syncytial virus.
GAS is the most common cause of bacterial pharyngitis, but other bacteria can also cause acute pharyngitis. Other bacterial causes of acute pharyngitis include groups C and G β-hemolytic streptococci and C. diphtheriae.
Group C streptococcus (GCS) is a relatively common cause of acute pharyngitis among college students and adults. In addition to endemic pharyngitis, GCS can cause epidemic food-borne pharyngitis after ingestion of contaminated products, such as unpasteurized cow's milk.
GAS pharyngitis is the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Therefore, for a patient with acute pharyngitis, the clinical decision that usually needs to be made is whether or not the pharyngitis is attributable to GAS.

The original article with detail guideline can be accessed here.
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