What is included in the treatment plan for a patient presenting to the Emergency Room (ER) with a sore throat and noted to have erythema and edema on physical examination?

From the Guidelines

The treatment plan for a patient with a sore throat showing erythema and edema should focus on symptom relief and addressing the likely cause, with antibiotic therapy indicated for confirmed streptococcal pharyngitis, typically penicillin V or amoxicillin for 10 days, as recommended by the Infectious Diseases Society of America 1. For viral pharyngitis, which accounts for most cases, treatment includes:

• Rest
• Adequate hydration
• Over-the-counter pain relievers such as acetaminophen (325-650 mg every 4-6 hours) or ibuprofen (400-600 mg every 6-8 hours) For suspected streptococcal pharyngitis, after confirmation with rapid strep testing or throat culture, antibiotic therapy is indicated, with options including:
• Penicillin V (500 mg twice daily for 10 days)
• Amoxicillin (500 mg twice daily for 10 days)
• For penicillin-allergic patients, alternatives include cephalexin (if no anaphylactic reaction history) or macrolides like azithromycin (500 mg on day 1, then 250 mg daily for 4 days) 1 Symptomatic treatments should also include:
• Warm salt water gargles (1/4 teaspoon salt in 8 ounces of warm water) several times daily
• Throat lozenges
• Cool beverages or popsicles Patients should be advised to complete the full course of antibiotics if prescribed, even if symptoms improve, to prevent complications like rheumatic fever or peritonsillar abscess, as emphasized by the American College of Physicians and the Centers for Disease Control and Prevention 1. Hospitalization may be necessary for severe cases with significant dehydration, inability to swallow, or airway compromise.

From the FDA Drug Label

Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. Table 1 (12 weeks) n 40 kg Recommended Dosage for Pediatric Patients Aged 3 Months and Older and Weight Less than 40 kg Ear/Nose/Throat Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours Severe 875 mg every 12 hours or 500 mg every 8 hours

The treatment plan for a patient with a sore throat and erythema and edema on physical exam includes amoxicillin. The recommended dosage is:

• For mild to moderate Ear/Nose/Throat infections: 500 mg every 12 hours or 250 mg every 8 hours
• For severe Ear/Nose/Throat infections: 875 mg every 12 hours or 500 mg every 8 hours Treatment should be continued for at least 10 days to prevent the occurrence of acute rheumatic fever, and for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained 2 2.

From the Research

Treatment Plan for Sore Throat with Erythema and Edema

• The treatment plan for a patient presenting with sore throat and noted to have erythema and edema on physical exam may include antibiotics, pain management, and symptomatic relief 3, 4.
• First-line treatment for Group A beta-hemolytic streptococcal (GABHS) pharyngitis includes a 10-day course of penicillin or amoxicillin 3, 4.
• Patients allergic to penicillin can be treated with first-generation cephalosporins, clindamycin, or macrolide antibiotics 3, 4.
• Nonsteroidal anti-inflammatory drugs are more effective than acetaminophen and placebo for treatment of fever and pain associated with GABHS pharyngitis 3.
• Medicated throat lozenges used every two hours are also effective in providing symptomatic relief 3.
• Corticosteroids are not recommended for routine use in the treatment of GABHS pharyngitis, as they provide only a small reduction in the duration of symptoms 3, 4.

Antibiotic Treatment Options

• Cephalosporins versus penicillin: there is low-certainty evidence that cephalosporins may be as effective as penicillin in resolving symptoms, but may have a lower risk of clinical relapse 5.
• Macrolides versus penicillin: there is low-certainty evidence that macrolides may be as effective as penicillin in resolving symptoms, but may have a higher risk of adverse events 5.
• Azithromycin versus amoxicillin: there is very low-certainty evidence that azithromycin may be as effective as amoxicillin in resolving symptoms, but may have a higher risk of adverse events 5.
• Carbacephem versus penicillin: there is low-certainty evidence that carbacephem may be more effective than penicillin in resolving symptoms 5.

Considerations for Treatment

• The choice of antibiotic should be based on the patient's age, allergy history, and severity of symptoms 3, 4.
• The duration of antibiotic treatment should be 10 days for penicillin or amoxicillin, and may be shorter for other antibiotics 6.
• Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 4.