treatment of pharyngitis

Caring for Kids, Their Health and illness, by Dr Kondekar Santosh - Pediatrician Mumbai


its true that most pediatric pharyngitis (below 2 yr age) are viral in origin, and bacteria including streptococci are commonly grown from pediatric throats even though the child is asymptomatic. So it becomes relatively unnecessary to perform throat cultures.

"Viruses are isolated in approximately 40% of cases and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus (mononucleosis), and cytomegalovirus. Primary bacterial pathogens that account for approximately 30% of cases of pharyngitis in children include GABHS (common), group C streptococci (uncommon), group G streptococci (uncommon), Neisseria gonorrhoeae (uncommon), Corynebacterium diphtheriae (rare), and Corynebacterium hemolyticum (extremely rare)."(ref:http://www.emedicine.com/EMERG/topic395.htm)

Where as its easy to suspect a viral aetiology if some of the symptoms and or signs are present; viz: typical prodrome, cold, conjuctivitis, rhinorhea, wheezing etc; its absence doesnt truly mean its bacterial in origin.

Bacterial sorethroat similarly has some of the characteristic findings like white patch/ granular inflammation /microabscess / associated acute lymphnode enlargement / lymph node tenderness, sinus tenderness, scarlet rash / membrane etc. But absence of these findings may help one suspect strongly a nonbacterial infection.True nothing is certain.

The real reason to treat pharyngitis emperically and urgently; is the risk of its sequalae like glomerulonephritis, rheumatic fever and kawasaki disease.These risks are always there with even asymptomatic streptococcal pharyngitis; but documentation of streptococcal throat culture negative after therapy gives some clinical satisfaction in curtailing at least some of GABHS disease.

I preer to stick only to conservative therapy in throat infections, mainly because most of throat and related infections in children below 2 years are viral origin and in children above 2 years, bacterial infections usually localise and also give enough time to observe/evaluatethe course of disease.

The therapy that works best is soothing normal saline nebulisation for throat relief, added to paracetamol for relief from fever and malaise for 2-3 days; keeping a close watch on development of any diagnostic signs for viral /bacterial aetiology, and if required, antibiotics; after a CBC / ASLO / culture as per the regional recommendations.

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its true that most pediatric pharyngitis (below 2 yr age) are viral in origin, and bacteria including streptococci are commonly grown from pediatric throats even though the child is asymptomatic. So it becomes relatively unnecessary to perform throat cultures.

"Viruses are isolated in approximately 40% of cases and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus (mononucleosis), and cytomegalovirus. Primary bacterial pathogens that account for approximately 30% of cases of pharyngitis in children include GABHS (common), group C streptococci (uncommon), group G streptococci (uncommon), Neisseria gonorrhoeae (uncommon), Corynebacterium diphtheriae (rare), and Corynebacterium hemolyticum (extremely rare)."(ref:http://www.emedicine.com/EMERG/topic395.htm)

Where as its easy to suspect a viral aetiology if some of the symptoms and or signs are present; viz: typical prodrome, cold, conjuctivitis, rhinorhea, wheezing etc; its absence doesnt truly mean its bacterial in origin.

Bacterial sorethroat similarly has some of the characteristic findings like white patch/ granular inflammation /microabscess / associated acute lymphnode enlargement / lymph node tenderness, sinus tenderness, scarlet rash / membrane etc. But absence of these findings may help one suspect strongly a nonbacterial infection.True; nothing is certain.

The real reason to treat pharyngitis emperically and urgently; is the risk of its sequalae like glomerulonephritis, rheumatic fever and kawasaki disease.These risks are always there with even asymptomatic streptococcal pharyngitis; but documentation of streptococcal throat culture negative after therapy gives some clinical satisfaction in curtailing at least some of GABHS disease.

I preer to stick only to conservative therapy in throat infections, mainly because most of throat and related infections in children below 2 years are viral origin and in children above 2 years, bacterial infections usually localise and also give enough time to observe/evaluatethe course of disease.

The therapy that works best is soothing normal saline nebulisation for throat relief, added to paracetamol for relief from fever and malaise for 2-3 days; keeping a close watch on development of any diagnostic signs for viral /bacterial aetiology, and if required, antibiotics; after a CBC / ASLO / culture as per the regional recommendations.

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Dr kondekar santosh venketraman
child health specialist at HIS best!
9869405747 Pediatrician;
seth G S Medical colllege
KEM Hospital - ParelMumbai
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