What is the treatment for an 8-month-old infant with suspected pharyngitis (inflammation of the throat) who is exhibiting anorexia (loss of appetite)?

From the Guidelines

For an 8-month-old with a suspected sore throat who is refusing to eat, the primary focus should be on supportive care while monitoring for serious symptoms, as most infant sore throats are viral and resolve on their own 1.

Supportive Care

• Offer small, frequent sips of breast milk, formula, or water to prevent dehydration.
• Administer acetaminophen (Tylenol) at 10-15 mg/kg every 4-6 hours to reduce pain and fever; for an average 8-month-old weighing about 8-9 kg, this would be about 80-135 mg (or 2.5-4.2 mL of infant Tylenol 160 mg/5mL) 1.
• Provide cold foods like yogurt or pureed fruit, which may be soothing.
• Avoid giving honey due to the risk of infant botulism and aspirin due to the risk of Reye's syndrome 1.

Monitoring for Serious Symptoms

• Contact a doctor immediately if the baby shows:
  • Difficulty breathing
  • Excessive drooling
  • Refusal to drink
  • Fewer wet diapers
  • Development of a rash
  • Fever over 102°F (38.9°C)
  • Symptoms persisting beyond 2-3 days
• The doctor might perform a throat culture to determine the cause before prescribing treatment, especially if bacterial infections like strep throat are suspected, though they are uncommon in babies this age 1.

Antibiotic Use

• Antibiotics are only indicated for bacterial infections, and their use should be guided by a throat culture or rapid antigen detection test (RADT) to confirm the presence of group A streptococcal pharyngitis 1.
• If antibiotics are prescribed, options for children include amoxicillin, penicillin V, or other antibiotics as recommended by guidelines, with the specific choice depending on factors like allergy history and local resistance patterns 1.

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 Due to incompletely developed renal function affecting elimination of amoxicillin in this age group, the recommended upper dose of amoxicillin is 30 mg/kg/day divided every 12 hours.

For an 8-month-old patient with a suspected sore throat and not wanting to eat, the treatment with amoxicillin should be considered if the infection is proven or strongly suspected to be caused by bacteria.

• The recommended dose for a patient aged less than 12 weeks (3 months) is 30 mg/kg/day divided every 12 hours.
• The 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 2.

From the Research

Treatment of Suspected Sore Throat in an 8-Month-Old

• The treatment of suspected sore throat in an 8-month-old not wanting to eat is primarily focused on determining the cause of the sore throat, whether it be viral or bacterial, and providing appropriate care 3, 4, 5, 6, 7.
• Clinical decision rules, such as the modified Centor score, can be used to assess the risk of group A beta-hemolytic streptococcal infection, which is a common cause of bacterial pharyngitis 5.
• Rapid antigen detection tests and throat cultures can be used to diagnose streptococcal pharyngitis, with throat culture being the diagnostic standard 5.
• If the diagnosis is unclear, a rapid antigen test can be performed, and if the result is negative, a throat culture may be recommended, especially in children and adolescents 3, 4.

Antibiotic Treatment

• Penicillin and amoxicillin are the first-line antibiotics for the treatment of streptococcal pharyngitis, with a recommended course of 10 days 3, 5, 7.
• First-generation cephalosporins are recommended for patients with non-anaphylactic allergies to penicillin 3, 5.
• Macrolides, such as azithromycin and clarithromycin, are not recommended as first-line therapy due to significant resistance in some parts of the United States 3.

Symptomatic Treatment

• Steroids are not recommended for symptomatic treatment of sore throat 3.
• Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 3.
• Tonsillectomy is rarely recommended as a preventive measure for recurrent streptococcal pharyngitis, and the benefits are generally considered to be too small to outweigh the associated costs and surgical risks 3, 5.