From the Guidelines
For a 24-year-old patient with an elevated WBC count of 15,000/μL, sore throat for 11 days, and negative Monospot test, I recommend empiric treatment with penicillin V potassium 500 mg orally twice daily for 10 days or amoxicillin 500 mg three times daily for 10 days, as the patient likely has a bacterial pharyngitis, possibly Group A Streptococcus (GAS), given the prolonged symptoms and elevated white blood cell count 1. The patient's symptoms, including a sore throat for 11 days and an elevated WBC count, suggest a bacterial infection, and the negative Monospot test makes infectious mononucleosis less likely, but does not completely rule it out 1.
- The Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use, and the patient's symptoms meet the criteria for further testing 1.
- Before starting antibiotics, obtaining a throat culture to confirm the diagnosis is recommended, and if the patient has penicillin allergy, alternatives include azithromycin or clindamycin 1.
- Symptomatic relief with acetaminophen or ibuprofen for pain and fever, salt water gargles, and adequate hydration is also recommended 1.
- If symptoms persist despite antibiotic therapy, consider additional testing for other causes such as Epstein-Barr virus serology, Mycoplasma, or Chlamydia pneumoniae 1.
From the Research
Patient Assessment
- The patient is 24 years old with a WBC count of 15 and has had a sore throat for 11 days.
- The Monotest result is negative, which does not definitively rule out group A beta-hemolytic streptococcal pharyngitis 2.
Diagnostic Considerations
- Clinical findings are unreliable for diagnosing group A beta-hemolytic streptococcal pharyngitis, and a rapid streptococcal test or throat culture should be performed to confirm the diagnosis 2.
- The Centor or FeverPAIN score can be used to assess the risk of group A beta-hemolytic streptococcal pharyngitis, with a score of 2 or 3 indicating a higher risk 3, 4.
- A throat culture is recommended after a negative rapid antigen test result, especially in children and adolescents 5.
Treatment Options
- If group A beta-hemolytic streptococcal pharyngitis is suspected, a 10-day course of penicillin or amoxicillin is recommended as first-line treatment 3, 5.
- For patients allergic to penicillin, first-generation cephalosporins, clindamycin, or macrolide antibiotics can be used as alternatives 3, 5.
- Symptomatic treatment with nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, can help manage fever and pain 3, 4.
- Corticosteroids are not recommended for routine use in treating group A beta-hemolytic streptococcal pharyngitis 3.