From the Guidelines
Eight-year-old children typically get a sore throat with nausea due to viral infections like the common cold, flu, or strep throat, with the most likely cause being a viral infection, and only a minority of cases are caused by bacterial infections such as Group A Streptococcal (GAS) pharyngitis 1.
Causes of Pharyngitis
The causes of pharyngitis can be broadly categorized into viral and bacterial infections. Viral infections are the most common cause of pharyngitis, with viruses such as influenza, parainfluenza, rhinovirus, coronavirus, adenovirus, respiratory syncytial virus, Epstein-Barr virus, enteroviruses, and herpesviruses being common culprits 1. Bacterial infections, on the other hand, are less common, with Group A Streptococcal (GAS) pharyngitis being the most significant bacterial cause.
Diagnosis of GAS Pharyngitis
The diagnosis of GAS pharyngitis can be challenging, as the signs and symptoms of GAS and nonstreptococcal pharyngitis overlap broadly 1. A laboratory test, such as a throat culture or a rapid antigen detection test (RADT), is required to confirm the diagnosis of GAS pharyngitis 1. The RADT is less sensitive than throat cultures, and a negative RADT should be confirmed with a throat culture 1.
Management of Pharyngitis
For symptom relief, children can take weight-appropriate doses of acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) - typically 160-320mg of acetaminophen or 100-200mg of ibuprofen every 6-8 hours as needed for discomfort. Warm salt water gargles (1/4 teaspoon salt in 8oz warm water) can soothe the throat, while staying hydrated with clear fluids helps manage both throat pain and nausea. Cold foods like popsicles or ice cream may provide temporary relief. If symptoms include fever over 101°F lasting more than 2-3 days, difficulty swallowing, severe pain, white patches in the throat, or if the child appears very ill, parents should seek medical attention promptly as these could indicate strep throat requiring antibiotics 1. Most viral causes will resolve within 7-10 days with supportive care.
Antibiotic Treatment for GAS Pharyngitis
For individuals without penicillin allergy, antibiotic regimens recommended for GAS pharyngitis include penicillin V, amoxicillin, and benzathine penicillin G 1. For individuals with penicillin allergy, alternative antibiotics such as cephalexin, cefadroxil, clindamycin, azithromycin, and clarithromycin can be used 1. The choice of antibiotic and duration of treatment should be guided by the severity of symptoms, patient age, and local resistance patterns.
From the Research
Causes of Pharyngitis with Nausea in an 8-year-old Child
- Pharyngitis can be caused by several etiologies, with bacterial pharyngitis being the most important 2
- Group A beta-hemolytic streptococcus (GABHS) infection is a common cause of pharyngitis in children, and is more common in children aged 5-15 years 3
- Symptoms of GABHS pharyngitis include sore throat, fever, tender anterior cervical adenopathy, tonsillar exudates, and headache 3, 4
- Nausea is not a typical symptom of GABHS pharyngitis, but can occur in some cases 4
- Viral pharyngitis is also a common cause of pharyngitis in children, and can be accompanied by symptoms such as cough, coryza, conjunctivitis, and diarrhea 4, 5
Diagnosis and Treatment
- Diagnosis of GABHS pharyngitis can be made using a rapid antigen detection test or throat culture 2, 3, 4
- Treatment of GABHS pharyngitis typically involves a 10-day course of penicillin or amoxicillin 3, 4
- Nonsteroidal anti-inflammatory drugs and medicated throat lozenges can be used to treat fever and pain associated with GABHS pharyngitis 3
- Corticosteroids are not typically used to treat GABHS pharyngitis, as they provide only a small reduction in the duration of symptoms 3