From the Guidelines
Given the patient's presentation with a sore throat, fever, positive strep test, and uvular deviation to the right, immediate imaging with a contrast-enhanced CT scan of the neck is recommended. This finding suggests a potential peritonsillar abscess, which is a collection of pus between the tonsillar capsule and pharyngeal muscles. The CT scan will help confirm the diagnosis and determine the extent of the abscess. Additional testing should include complete blood count to assess for leukocytosis and blood cultures if systemic infection is suspected, as recommended by the Infectious Diseases Society of America 1.
The patient's symptoms and physical examination findings, such as uvular deviation, are consistent with a peritonsillar abscess, which requires prompt diagnosis and treatment to prevent complications such as airway obstruction or spread of infection to deep neck spaces. The use of antibiotics, such as ampicillin-sulbactam or clindamycin, is also recommended, as outlined in the guidelines for the diagnosis and management of group A streptococcal pharyngitis 1.
It is essential to note that the patient's positive strep test and symptoms are consistent with acute streptococcal pharyngitis, and the guidelines recommend antimicrobial therapy to eradicate the infecting organism from the pharynx, as stated in the practice guidelines for the diagnosis and management of group A streptococcal pharyngitis 1. However, the presence of uvular deviation suggests a potential complication, such as a peritonsillar abscess, which requires further evaluation and treatment.
In terms of specific testing, the guidelines do not recommend routine follow-up posttreatment throat cultures or RADT, but may be considered in special circumstances, such as persistent symptoms or suspected treatment failure 1. The patient's presentation and physical examination findings should guide the choice of diagnostic tests and treatment.
Key points to consider in the management of this patient include:
- Immediate imaging with a contrast-enhanced CT scan of the neck to confirm the diagnosis and determine the extent of the abscess
- Additional testing, such as complete blood count and blood cultures, to assess for systemic infection
- Antibiotic therapy, such as ampicillin-sulbactam or clindamycin, to treat the underlying infection
- Consideration of special circumstances, such as persistent symptoms or suspected treatment failure, when determining the need for follow-up testing or alternative treatment strategies.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Further Examination and Testing
Given the patient's symptoms and positive test for strep, the following testing and examinations should be considered:
- A thorough physical examination to assess for any signs of complications or other conditions that may be contributing to the patient's symptoms 2, 3
- A review of the patient's medical history to identify any potential allergies or sensitivities to antibiotics 2, 3
- Imaging studies, such as a CT scan or MRI, to evaluate the patient's uvula and surrounding tissues, particularly given the displacement of the uvula to the right 4
- A complete blood count (CBC) to assess for any signs of infection or inflammation 5
- Blood cultures to rule out any potential bacterial infections 6
Diagnostic Considerations
When diagnosing group A streptococcal pharyngitis, the following diagnostic methods can be used:
- Rapid antigen detection tests 2, 3, 4
- Throat culture 2, 3, 6, 4
- Clinical scoring systems, such as the modified Centor or FeverPAIN score 2, 3
- Nucleic acid amplification tests 4
Treatment Considerations
The patient's treatment plan should be guided by the results of the diagnostic tests and examinations, as well as their medical history and potential allergies or sensitivities. The following treatment options may be considered: