What is the workup for pharyngitis and cough?

From the Guidelines

Workup for Pharyngitis and Cough A thorough workup and history should be taken to determine the underlying cause of pharyngitis and cough, as most cases are viral in nature and do not require antibiotic treatment 1.

Recommendation

Start by asking about the duration of symptoms, severity, and any associated symptoms such as fever, shortness of breath, or difficulty swallowing.

History

• Inquire about recent travel, exposure to sick contacts, or recent antibiotic use.
• Ask about any underlying medical conditions, such as asthma, COPD, or immunocompromised states.
• Determine if the patient has a history of allergies or previous similar episodes.

Workup

• Perform a physical exam to assess for signs of respiratory distress, lymphadenopathy, or tonsillar exudates.
• Obtain a complete blood count (CBC) to evaluate for signs of infection or inflammation.
• Consider a rapid streptococcal antigen test or throat culture if streptococcal pharyngitis is suspected, as antibiotics may prevent complications from group A streptococcal infection 1.
• If pneumonia is suspected, obtain a chest radiograph.

Treatment

• For viral pharyngitis, recommend symptomatic treatment with acetaminophen (650mg every 4-6 hours) or ibuprofen (400mg every 4-6 hours) for pain and fever management.
• For streptococcal pharyngitis, prescribe penicillin VK (250-500mg every 6 hours for 10 days) or amoxicillin (500mg every 8 hours for 10 days) 1.
• For cough, recommend a trial of dextromethorphan (15-30mg every 4-6 hours) or guaifenesin (200-400mg every 4-6 hours) 1.

Key Points

• Antibiotics should only be prescribed if a bacterial cause is suspected or confirmed 1.
• The modified Centor criteria can be used to determine the likelihood of a bacterial cause, and patients who meet fewer than 3 criteria do not need to be tested 1.
• Patients with a chronic cough should be systematically directed towards empiric treatment at the most common causes of cough, including UACS, asthma, NAEB, and GERD 1.

From the Research

Workup for Pharyngitis

• The workup for pharyngitis typically involves a directed history and physical examination to narrow down the possible diagnoses 2, 3.
• The history should include questions about associated symptoms, duration of symptoms, and epidemiologic factors 2, 3.
• The physical examination should look for signs of exudative pharyngitis, fever, adenopathy, and lack of cough or other respiratory symptoms 3.
• Clinical scores, such as the Centor, McIsaac, and FeverPAIN scores, can be used to assess the risk of bacterial pharyngitis and guide antibiotic treatment 4.

Workup for Cough

• The workup for cough typically involves a comprehensive history and physical examination to suggest the correct diagnosis 5.
• A chest roentgenogram is an essential part of the workup for cough, as it may suggest tuberculosis, chronic fungal infection, bronchiectasis, or lung abscess 5.
• Pulmonary function studies can be helpful in the workup of the patient with chronic cough, particularly in diagnosing obstructive or restrictive lung disease 5.
• Bronchoprovocation testing can be helpful when baseline pulmonary function tests are normal and the diagnosis of postviral bronchitis or cough-variant asthma is suggested 5.

Common Causes and Diagnostic Approaches

• Sore throat is most commonly caused by an infectious, inflammatory, or neoplastic etiologic factor 2.
• Cough is a common symptom that can be caused by a variety of conditions, including chronic rhinosinusitis, asthma, and bronchiectasis 5.
• A thorough history and examination are vital to the correct diagnosis of both pharyngitis and cough, and a high index of suspicion must be maintained to diagnose less common but serious pathology 6.