Can you provide a sample SOAP note for a previously healthy 12-year-old presenting with acute streptococcal pharyngitis?

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Sample SOAP Note for Streptococcal Pharyngitis in a 12-Year-Old

SUBJECTIVE

Chief Complaint: Sore throat and fever

History of Present Illness:

  • 12-year-old previously healthy patient presents with acute onset of sore throat for 2 days
  • Associated symptoms: fever (reported 102°F at home), pain with swallowing, headache
  • May report abdominal pain, nausea (common in children) 1
  • Absence of viral symptoms: No cough, rhinorrhea, hoarseness, or oral ulcers 2
  • Possible exposure to known strep case at school
  • No difficulty breathing or drooling

Past Medical History: None
Medications: None
Allergies: NKDA
Immunizations: Up to date

OBJECTIVE

Vital Signs:

  • Temperature: 102.5°F (39.2°C)
  • Heart Rate: 98 bpm
  • Blood Pressure: 110/70 mmHg
  • Respiratory Rate: 18/min
  • SpO2: 99% on room air

Physical Examination:

General: Alert, appears mildly uncomfortable but not toxic

HEENT:

  • Pharynx: Marked tonsillopharyngeal erythema with bilateral tonsillar exudates
  • Soft palate petechiae present
  • Uvula: Erythematous and edematous ("beefy red swollen uvula") 1
  • No oral ulcers, no rhinorrhea

Neck: Tender bilateral anterior cervical lymphadenopathy (1.5 cm nodes)

Lungs: Clear to auscultation bilaterally, no cough

Skin: No scarlatiniform rash noted

Diagnostic Testing:

  • Rapid Antigen Detection Test (RADT): Positive for Group A Streptococcus
  • Note: Positive RADT does not require backup throat culture due to high specificity 2

ASSESSMENT

Acute Group A Streptococcal Pharyngitis

Clinical reasoning: This 12-year-old falls within the peak age range (5-15 years) for GAS pharyngitis 1. The presentation includes classic features: sudden onset sore throat, fever 101-104°F, tonsillar exudates, anterior cervical lymphadenopathy, and absence of viral symptoms (no cough, rhinorrhea, or hoarseness). Positive RADT confirms diagnosis and no backup culture is needed 2.

PLAN

Antibiotic Therapy

First-line treatment: Amoxicillin 50 mg/kg once daily (maximum 1000 mg) for 10 days 2

For this 40 kg patient: Amoxicillin 500 mg PO twice daily for 10 days

Alternative first-line option: Penicillin V 250 mg PO three times daily for 10 days 2

Rationale: Penicillin and amoxicillin are first-line agents based on narrow spectrum, low adverse effects, modest cost, and strong evidence for preventing acute rheumatic fever and suppurative complications 2. The 10-day duration is essential to eradicate GAS from the pharynx 2.

Symptomatic Management

  • Ibuprofen 400 mg PO every 6 hours as needed for pain and fever (strong evidence over acetaminophen) 2
  • Avoid aspirin (risk of Reye syndrome in children) 2
  • Do not prescribe corticosteroids (weak evidence, not recommended routinely) 2
  • Encourage adequate hydration and rest

Patient/Parent Education

  • Contagiousness: Patient can return to school 24 hours after starting antibiotics 2
  • Complete full 10-day antibiotic course even if symptoms improve
  • Expected improvement within 24-48 hours of starting antibiotics
  • Red flags for return: Worsening symptoms after starting antibiotics, difficulty breathing, drooling, inability to swallow, or symptoms persisting beyond 5 days of treatment 3

Follow-Up

  • No routine follow-up testing needed (post-treatment cultures not recommended) 2
  • Return if symptoms worsen or persist beyond 5 days of treatment
  • Do not test or treat asymptomatic household contacts 2

Important Caveats

If penicillin allergy were present:

  • Non-anaphylactic allergy: Cephalexin 20 mg/kg/dose twice daily for 10 days 2
  • Anaphylactic allergy: Clindamycin 7 mg/kg three times daily for 10 days OR azithromycin 12 mg/kg once daily for 5 days 2
  • Note: Macrolide resistance varies geographically; consider local resistance patterns 2

This approach prevents acute rheumatic fever, suppurative complications (peritonsillar abscess, cervical lymphadenitis), shortens symptom duration, and reduces transmission 2.

References

3
Research

Streptococcal Pharyngitis: Rapid Evidence Review.

American family physician, 2024

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.