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Pharmacists and other clinicians share responsibility for relieving symptoms, preventing transmission, and avoiding complications.
Pharyngitis, an inflammation of the back of the throat, can be bacterial or viral.
Streptococcal pharyngitis, commonly referred to as strep throat, is caused by Streptococcus pyogenes, group A β-hemolytic Streptococci (GAS).1,2 GAS is responsible for fewer pharyngitis cases than viruses are (adults: 5%-15%, children: 20%-30%).1-3 Strep throat spreads through direct contact with respiratory fluids and has an incubation period of 2 to 5 days.2,3 Its prevalence increases during the winter and early spring, accounting for 1% to 2% of all ambulatory care visits in the United States.2,4
Recognizing Signs/Symptoms
Differentiating between a bacterial and viral etiology is difficult, especially in pediatric patients, which often results in antibiotic overprescribing. Of note, patients who present with clear viral signs and symptoms (Table 11-6) do not require testing and should not receive antibiotics.2,5,6 Conversely, symptoms of GAS pharyngitis are nonspecific.
Treatment: Antibiotics and Supportive Care
The Infectious Disease Society of America’s guidelines highly recommend antibiotic treatment in children who tested positive for strep throat. Treatment prevents nonsuppurative (eg, acute rheumatic fever [ARF], acute glomerulonephritis) and suppurative (eg, cervical lymphadenitis, mastoiditis, and peritonsillar abscess) complications.2,4 Adult patients often do not need antibiotics because the relief they provide is minimal. Symptoms are self-limiting and usually last less than a week.4 Table 22-4,6-8 summarizes antibiotic therapy options. Guidelines consider amoxicillin/penicillin as first-line therapy, followed by cephalosporins and macrolides/azalides in the presence of allergy to first-line agents. Avoid fluoroquinolones, sulfonamides, and tetracyclines because of high resistance rates, ineffectiveness, and/or unnecessary broad-spectrum coverage.2 Study results show that children experience more adverse events, notably gastrointestinal upset, when prescribed azalides/macrolides compared with β-lactam antibiotics. Rashes are more common with β-lactams.9
Guidelines do not recommend antibiotic use in asymptomatic individuals positive for GAS pharyngitis, as they are likely chronic carriers at no/minimal risk of complications and not contagious.1-6 Similarly, recent exposure does not warrant testing if asymptomatic.2,3,6 The exceptions are patients with family or personal histories of ARF and post-streptococcal glomerulonephritis. Asymptomatic and symptomatic GAS infections can prompt ARF recurrence. Experts also recommend secondary prophylaxis in patients with a history of ARF.3,10
Key Counseling Points
Here are tips to share with patients:
Patients with clear viral symptoms do not require testing or antibiotics.2 Children younger than 3 years of age do not require testing unless symptomatic with a known exposure.2,6
Conclusion
Patients with pharyngitis often seek medical guidance. Assessing and counseling them on common adverse effects, hygiene, and supportive care prevent complications and transmission of infections. Pharmacists can help ensure the selection of appropriate antibiotic therapy.
Justyna Sudyka is a PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.
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