Friday, August 25, 2017

Treatment of streptococcal tonsillopharyngitis: Important points for USMLE


Here's a quick post of treatment of "strep throat" (my slang for "Tonsillopharyngitis due to Streptococcus pyogenes, also known as group A Streptococcus.")

Why treat:
Reduces duration and severity of clinical signs and symptoms.
Reduces transmission to close contacts by reducing infectivity.
Reduces incidence of nonsuppurative complications (eg, acute rheumatic fever) - IMPORTANT!

Who to treat:
Symptomatic pharyngitis if the presence of group A streptococci in the pharynx is confirmed by culture or rapid antigen detection testing (RADT).
Clinical and/or epidemiologic factors point to a high index of suspicion for GAS pharyngitis.

Drug of choice: Oral penicillin V

Yummy yumm: Amoxicillin is often used in place of oral penicillin in children, since the taste of the amoxicillin suspension is more palatable

Treatment failure or beta-lactam hypersensitivity: First-generation cephalosporins (such as cephalexin and cefadroxil).

Clinical improvement: Within the first few days.

Duration of oral antibiotic therapy: 10 days (for prevention of ARF!)

Test of cure:  Not necessary.


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