Pharyngitis,Diagnosis and Empiric antibiotic treatment Considerations

Pharyngitis is the common disorder more in children than adults. Pharyngitis is common in the developing countries. In the United States pharyngitis is diagnosed in 11 million patients in emergency department and ambulatory setting annually. Viruses are frequently cause of viral pharyngitis, with adenovirus, rhinovirus, enterovirus, influenza A and B parainfluenza viruses. Streptococcus pyogenes group A(GAS) or group A beta hemolytic streptococcus(GABS) is the bacterial agent of acute pharyngitis. Fusobacterium necrophorum and Mycoplasma pneumonia also been reported. Virulence factors leads to pharyngitis, invasive disease, acute rheumatic fever, and acute glomerulonephritis. Bacterial signs include pharyngea lerythema, tonsillar enlargement, and grayish-whitish exudate covering the posterior pharynx and tonsillar pillars. Symptoms such as conjunctivitis, coryza, oral ulcers, cough and diarrhea suggest a viral cause. Modified Centor score may be used for diagnosis. A 10 days course of penicillin remains treatment of choice, macrolide for penicillin allergic patients, amoxicillin has the advantage of less frequent dosing. Use of broad spectrum antibiotics thought to contribute to antibiotic resistance. Role of tonsillectomy or adenoidectomy in GBHS pharyngitis incidence is poorly understood.