Sore Throat

INTRODUCTION

Key examination

• On inspection, note the general appearance, look for toxicity, the anaemic pallor of leukaemia, the nasal stuffiness of infectious mononucleosis or the halitosis of a streptococcal throat.

• Palpate the neck for soreness and lymphadenopathy and check the sinus area.

• Then inspect the oral cavity and pharynx.

Key investigations

Consider:

• throat swab

• FBE

• mononucleosis test

• blood sugar

• biopsy of suspicious lesions

Symptomatic treatment of sore throat

• Most acute sore throats are caused by viral infection—treat symptomatically

• Adequate soothing fluids, incl. icy poles

• Analgesia: adults—2 soluble aspirin or paracetamol; children—paracetamol elixir (not alcohol base)

• Rest with adequate fluid intake

• Soothing gargles (e.g. soluble aspirin used for analgesia)

• Advice against overuse of OTC throat lozenges and topical sprays, which can sensitise the throat

STREPTOCOCCAL TONSILLOPHARYNGITIS

Four key diagnostic features of GABHS throat infection

• Fever >38°C with toxicity

• Tender cervical lymphadenopathy

• Tonsillar exudate

• No cough

Throat swabs are about 90% effective in isolating GABHS from the infected throat if clinical infection present. It should be treated with penicillin or an alternative antibiotic.

Indications for antibiotic therapy

• Severe tonsillitis with above features of GABHS

• Existing rheumatic heart disease at any age

• Scarlet fever

• Peritonsillar cellulitis or abscess (quinsy)

• Patients 2–25 yrs with presumptive GABHS from special communities (e.g. remote Indigenous) with a high incidence of acute rheumatic fever

One evidence-based review recommended that if a cold follows its natural course no antibiotics will be helpful. If there is a sore throat with no cough, but fever >38°C, tender neck glands and white spots in the throat, antibiotics are indicated.

Treatment for streptococcal throat (proven or suspected)

Children

• Phenoxymethylpenicillin 50 mg/kg/d (o) in 2 divided doses for 10 d (to max. 1 g/d) or

• (If sensitive to penicillin) azithromycin 12 mg/kg up to 500 mg (o) daily for 5 days or cephalexin 25 mg/kg (o) up to 1 g bd for 10 days

Adults

• Phenoxymethylpenicillin 500 mg (o) 12 hrly for 10 d or

• Azithromycin 500 ...