What is included in emergency department (ED) care for pharyngitis (sore throat)?

Updated: May 06, 2020
  • Author: John R Acerra, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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See the list below:

  • Assess and secure the airway, if necessary.

  • Assess the patient for signs of toxicity, epiglottitis, or oropharyngeal abscess. [30]

  • Evaluate the hydration status because severe pharyngitis limits oral intake. Appropriate measures to rehydrate should be initiated, including intravenous hydration.

  • Assess for GAS infection if clinically suspected. A suggested algorithm as is follows.

    • In general, patients should not be treated without a positive culture or positive rapid antigen detection test result because of increasing antibiotic resistance. Guidelines from the Infectious Diseases Society of America (IDSA) and American Heart Association state that microbiologic confirmation (via a rapid antigen test or culture) is required for the diagnosis of GAS. [13, 7]

    • Perform rapid antigen detection test if GAS is clinically suspected based on history and physical examination. If positive, begin antibiotic therapy. Testing does not usually need to be performed on patients with acute pharyngitis whose clinical and epidemiologic features do not suggest GAS as the etiology (Centor score 0-1).

    • Patients who are positive for all 4 Centor criteria can often be treated with antibiotics without antigen testing or cultures if rapid antigen testing is not available.

    • It is important to note that the Centor criteria can be used to identify cases of pharyngitis that are likely viral (score 0-1) and do not need antigen testing. Patients with a Centor score of 4 should have confirmation of GAS infection with an antigen test before being treated with antibiotics, unless such testing is unavailable.

    • Household contacts of patients with GAS infection or scarlet fever should be treated for a full 10 days of antibiotics without testing only if they have symptoms consistent with GAS. [7] Asymptomatic contacts should not be treated.

    • If clinically doubtful or the above criteria are not met, it is best to await rapid antigen or culture results to initiate antibiotic therapy.

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