From the Guidelines
Pharyngitis in an 8-year-old child is most commonly caused by viral infections, accounting for about 70-85% of cases, with Group A Streptococcus being the most significant bacterial cause that requires treatment. The most common viral culprits include rhinovirus, adenovirus, coronavirus, and influenza virus, as noted in the study by 1. Bacterial infections are responsible for about 15-30% of cases. Other less common causes include allergies, environmental irritants like dry air or pollution, postnasal drip, and acid reflux.
Diagnosis and Treatment
For viral pharyngitis, treatment focuses on symptom relief with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours), warm salt water gargles, and plenty of fluids, as suggested by 1. If strep throat is confirmed through testing, antibiotics such as amoxicillin (50 mg/kg once daily, max = 1000 mg) for 10 days are prescribed to prevent complications like rheumatic fever, as recommended by 1.
Prevention of Spread
Children should be kept home from school until fever-free for 24 hours and, if on antibiotics for strep throat, until they've taken antibiotics for at least 24 hours to prevent spread to others, as advised by 1.
Key Points to Consider
- The diagnosis of GAS pharyngitis should be established through a throat culture or a rapid antigen detection test (RADT), as stated in 1 and 1.
- Testing for GAS pharyngitis is not recommended for children or adults with acute pharyngitis with clinical and epidemiological features that strongly suggest a viral etiology, as noted in 1.
- Follow-up posttreatment throat cultures or RADT are not recommended routinely but may be considered in special circumstances, as mentioned in 1.
From the FDA Drug Label
Pharyngitis/Tonsillitis In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes)
The cause of pharyngitis in an 8-year-old child is Group A β-hemolytic streptococci (GABHS or S. pyogenes), as indicated by the studies comparing azithromycin to penicillin V in the treatment of pharyngitis due to this pathogen 2.
From the Research
Causes of Pharyngitis in Children
Pharyngitis, or sore throat, is a common medical problem in the outpatient setting, resulting in more than seven million pediatric visits each year 3. The causes of pharyngitis can be divided into:
- Infectious etiologies, with viral infection being the most common cause 3
- Bacterial etiologies, such as group A β-hemolytic Streptococcus pyogenes (GAS) 3, 4, 5, 6, 7
Bacterial Causes
Group A β-hemolytic Streptococcus (GABHS) is the leading bacterial cause of acute pharyngitis in children and adolescents worldwide 5. GABHS pharyngitis typically presents with an abrupt onset of fever, intense pain in the throat, pain on swallowing, an inflamed pharynx, enlarged and erythematous tonsils, a red and swollen uvula, and enlarged tender anterior cervical lymph nodes 5.
Viral Causes
Viral pharyngitis is also a common cause of sore throat in children, although the symptoms may not be as severe as those caused by GABHS 6.
Diagnosis
Diagnosis of pharyngitis is dependent on complete and accurate history, distinct physical findings, and interpretation of adjunct diagnostic tests 6. Microbiologic testing, such as throat culture or rapid antigen detection test, is generally necessary to confirm the diagnosis of GABHS pharyngitis 4, 5, 7.
Other Causes
Other causes of pharyngitis in children include: