榨汁机最好品牌排行榜前十名 Clinical Practice Guidelines : Sore throat

See also

Sepsis Acute pain management Invasive group A streptococcal infections: management of household contacts Acute upper airway obstruction

Key points Viral pharyngitis is the most common cause of sore throat in children Group A streptococcus (GAS) is the most frequently implicated bacterial pathogen. It is usually self-limiting, difficult to distinguish from viral infection and empiric antibiotic therapy is not required for most patients Children identified to be at high-risk for acute rheumatic fever (ARF) should be treated with antibiotics if they develop a sore throat (irrespective of other clinical features) Background Viral infections are the most common cause of sore throat in children GAS pharyngitis is uncommon under 4 years of age GAS can cause non-suppurative complications (acute rheumatic fever, post-streptococcal glomerulonephritis) and suppurative complications (peritonsillar abscess, retropharyngeal abscess) Despite periodic surges in the incidence of invasive GAS (iGAS), there is no current evidence that treatment of suspected GAS pharyngitis with antibiotics will prevent invasive disease. However, clinicians are encouraged to consider iGAS in children who present with more severe illness and provide appropriate treatment (see Sepsis) Assessment

Any patient with impending airway obstruction should he minimal handling and be referred early to an experienced clinician for definitive airway management, see Acute upper airway obstruction

History Age and ethnicity Oral intake Associated viral features (cough, coryza, conjunctivitis, oropharyngeal ulcers, diarrhoea, typical viral rash) Infectious contacts (see Invasive group A streptococcal infections: management of household contacts)Household crowdingImmunosuppression (increased risk of iGAS and suppurative complications)Immunisation status (in particular HiB vaccination) High-risk groups for developing acute rheumatic fever (see Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease):Aboriginal and/or Torres Strait Islander people Māori and/or Pacific Islander people Personal history of rheumatic fever or rheumatic heart disease Those living in communities with high rates of ARF Examination

Children with signs of acute upper airway obstruction should he minimal examination to not upset the child further

Hydration status Fever Oral/pharyngeal ulcers Tonsillar exudates, hypertrophy, asymmetry Uvula deviation Tender anterior cervical lymphadenopathy Hepatosplenomegaly (EBV, CMV) Features of scarlet fever (GAS toxin response): blanching, erythematous, sandpaper-like rash, usually more prominent in skin creases flushed face/cheeks with peri-oral pallor red strawberry tongue confluent petechiae in skin creases (Pastia lines) Red flags Unwell/toxic appearance Respiratory distress Stridor Trismus Drooling “Hot potato” voice (muffled voice associated with pharyngeal/peritonsillar pathology) Torticollis Neck stiffness/fullness

In the acutely unwell child consider alternative diagnosis and/or complications of GAS pharyngitis

Management

*Supportive management: see treatment section below

Investigations Throat swab is not routinely recommended for sore throat Consider other investigations if: suspected suppurative complications (eg relevant imaging) hepatosplenomegaly (FBE, EBV serology, +/- monospot) Streptococcal serology has no role in diagnosis of GAS pharyngitis Treatment

Supportive management is adequate for most sore throats

Supportive management

Details

Simple analgesia

See Acute pain management

Corticosteroids

Consider in children with severe pain unresponsive to simple analgesia

dexamethasone 0.15 mg/kg (max 10 mg) oral/IV/IM as a single dose, or prednisolone 1 mg/kg (max 50 mg) oral as a single dose

Hydration

See Dehydration

Antibiotic therapy for suspected GAS pharyngitis

Empiric antibiotic treatment of all children presenting with a sore throat is not recommended (see management flow chart above). Antimicrobial recommendations may vary according to local antimicrobial susceptibility patterns. Refer to local guidelines

Antibiotic

Route

Dose

Duration

Phenoxymethylpenicillin

Oral

15 mg/kg (max 500 mg) BD

10 days

Amoxicillin (second line therapy for improved oral adherence)

Oral

50 mg/kg (max 1 g) daily

10 days

Poor adherence or oral therapy not tolerated

Benzathine benzylpenicillin (for administration, see Pain management information for health professionals)

20 kg 1,200,000 units (2.3 mL)

Single dose

Hypersensitivity to penicillins (excluding immediate hypersensitivity)

Cefalexin

Oral

20 mg/kg (1 g) BD

10 days

Immediate hypersensitivity to beta-lactams

Azithromycin

Oral

12 mg/kg (max 500 mg) daily

5 days

Management of suppurative complications

Antimicrobial recommendations may vary according to local antimicrobial susceptibility patterns. Refer to local guidelines

Features

Management

Peritonsillar abscess (Quinsy)

Fever, odynophagia, dysphagia (pooling/drooling), “hot potato” voice, trismus, peritonsillar swelling/erythema, uvula deviation

Refer to ENT for consideration of drainage

Antibiotics:

Benzylpenicillin 50 mg/kg (max 1.2 g) IV 6 hourly

Switch to oral therapy:

Phenoxymethylpenicillin 15 mg/kg (max 500 mg) oral BD to complete a total of 10 days of therapy (IV + oral inclusive)

Retropharyngeal/parapharyngeal abscess

Fever, odynophagia, dysphagia, neck swelling/tenderness (particularly in young infants), torticollis, limitation of neck extension, retropharyngeal bulge

Refer to ENT for consideration of imaging and ongoing management

Investigations:

Lateral neck X-ray: normal X-ray does not exclude the diagnosis CT with IV contrast is the imaging modality of choice when required. (Should only be performed with advanced airway management ailable)

Antibiotics:

Amoxicillin with clulanic acid 25 mg/kg (max 1 g) IV 8 hourly (dosing based on amoxicillin component)

Switch to oral therapy:

Amoxicillin with clulanic acid 22.5 mg/kg (max 875 mg) oral bd (dosing based on amoxicillin component)

Epiglottitis/Bacterial tracheitis Abrupt onset, respiratory distress, high grade fever, toxic looking, odynophagia, dysphagia, stridor, muffled “hot-potato” voice, tripod position with neck extension, cervical lymphadenopathy

Increased risk in children unimmunised to Haemophilus influenzae type B (HiB)

Minimising distress:

Defer all unnecessary examination/procedures/imaging until advanced airway management ailable Early ICU/anaesthetic/ENT review

Antibiotics:

Ceftriaxone 50 mg/kg (max 2 g) IV/IM daily for 5 days

Consider:

Dexamethasone 0.15 mg/kg (max 10 mg) oral/IV/IM/ stat, repeat in 24 hours prn Consider consultation with local paediatric team when Systemically unwell Suppurative complications are present Evidence of moderate/severe dehydration Significant pain poorly responsive to supportive management (including analgesia and steroids) Consider consultation with paediatric/ENT outpatient follow-up when 7 episodes of sore throat/tonsillitis in 1 year 5 infections/year for 2 consecutive years 3 infections/year for 3 consecutive years Recommendations may differ, please refer to local referral guidelines Consider transfer when Evidence of acute suppurative complications eg abscess formation Evidence of upper airway obstruction Significant comorbidities are present, eg immunosuppression (after discussion with relevant treating team)

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Consider discharge when Pain relief is adequate Tolerating appropriate oral intake Parent information

Kids Health Info: Tonsillitis Australian Commission on safety and Quality in Health Care: Sore Throat: Should I take antibiotics? What every parent should know about colds, coughs, earaches and sore throats

Last updated October 2024