HFHT's Choosing Wisely Newsletter
For the whole healthcare team.
Issue 65: Pharyngitis
As we head into another season of viruses, it is important to remember good antibiotics stewardship. Mathematical modelling has shown that by the year 2050, if we continue as we are now, more people will die world-wide from antibiotic-resistant infections than cancer.
In continuing with our current theme, we will explore pharyngitis next.
Case

A 21-year-old woman pesents with:
  • A 3-day history of fever and sore throat.
  • Not coughing; very mild coryza.

Examination:

  • Temperature 39C.
  • Erythematous oropharynx - no exudate.
  • No cervical lymphadenopathy.

What should you do?

a) No throat swab
b) Amoxicillin empirically
c) Throat swab and amoxicillin if GAS positive
d) Viral prescription

Uncomplicated Pharyngitis:

  • Most cases are viral.
  • You should consider antibiotics ONLY if a rapid strep test or a culture is positive.

You do not need a rapid strep test or culture IF:

  1. Modified McIsaac or Centor Score is ≤ 1.
  2. The patient has symptoms such as rhinorrhea, oral ulcers or hoarseness (these are signs of a viral infection).

Modified McIsaac/ Centor Score:
Back to our case...what to do?

  1. Throat swab and treat if GAS positive.
  2. Viral prescription.
The Viral Prescription and the Delayed Prescription are downloadable in custom format for Telus, Oscar and Accuro directly from Choosing Wisely Canada .  
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