What is the best course of treatment for a 39-year-old healthcare provider with a sore throat and fever, who has a history of recent exposure to sick children and presents with erythematous throat and a temperature of 37.8°C, but no chest pain, shortness of breath, or cough?

Treatment Recommendation for Acute Pharyngitis

For this 39-year-old healthcare provider with acute pharyngitis (sore throat, fever 37.8°C, erythematous throat), await the throat swab results before initiating antibiotics, and provide symptomatic treatment with ibuprofen or paracetamol in the interim. 1

Initial Assessment and Risk Stratification

This patient presents with clinical features that require systematic evaluation using validated scoring systems:

• Modified Centor Criteria assessment: The patient has fever (1 point), likely tonsillar exudate based on erythematous uncomfortable throat (1 point), no cough mentioned (1 point), age 39 years (0 points) = approximately 2-3 points 1, 2
• With a Centor score of 2-3, the probability of Group A Streptococcus (GAS) infection is intermediate (15-30%), making the throat swab appropriate and necessary before treatment decisions 1, 3

The absence of cough is particularly important as cough strongly suggests viral etiology, while its absence increases suspicion for bacterial pharyngitis 2, 3

Symptomatic Management While Awaiting Results

Immediate analgesic therapy is strongly recommended:

• Ibuprofen or paracetamol should be administered for fever and throat pain relief 1
• Ibuprofen (an NSAID) is more effective than paracetamol for reducing fever and pain in pharyngitis 1, 3
• These agents provide symptomatic relief without the risks associated with antibiotics when the diagnosis remains uncertain 1

Corticosteroids are NOT recommended even though this patient has moderate symptoms, as the benefit is minimal (approximately 5 hours of pain reduction) and does not justify routine use 1

Antibiotic Decision Algorithm Based on Throat Swab Results

If Throat Swab is POSITIVE for Group A Streptococcus:

First-line treatment: Penicillin V (phenoxymethylpenicillin) 250-500 mg orally every 6-8 hours for 10 days 1, 4, 2

Alternative acceptable regimens:

• Penicillin V 500 mg twice daily for 10 days 4
• Amoxicillin 500 mg every 8 hours or 875 mg every 12 hours for 10 days 5, 2

The 10-day duration is critical to prevent acute rheumatic fever, even though the patient will become non-contagious after 24 hours of antibiotic therapy 4, 5

For Penicillin Allergy (if applicable):

• First-generation cephalosporins (cefadroxil or cephalexin) for non-anaphylactic penicillin allergy 1, 2
• Clindamycin if cephalosporins cannot be used (approximately 1% resistance rate in the US) 1
• Macrolides (azithromycin, clarithromycin) are acceptable but be aware of 5-8% resistance rates in the United States 1, 2

Critical caveat: Never use broad-spectrum cephalosporins (cefaclor, cefuroxime, cefixime, cefdinir, cefpodoxime) as they are more expensive, select for resistant flora, and offer no advantage over narrow-spectrum agents 1

If Throat Swab is NEGATIVE for Group A Streptococcus:

Do NOT prescribe antibiotics 1

• Continue symptomatic treatment with NSAIDs or paracetamol 1
• The infection is likely viral and will resolve without antibiotics 1, 6
• Antibiotics in GAS-negative pharyngitis do not prevent complications and contribute to antimicrobial resistance 1

Special Considerations for This Healthcare Provider

Occupational exposure context:

• The patient's children were sick, suggesting possible viral transmission within the household 6
• Healthcare providers have higher exposure risk but this does not change the diagnostic or treatment approach 1

Return to work guidance:

• If GAS-positive and treated with antibiotics: non-contagious after 24 hours of appropriate antibiotic therapy 4
• If GAS-negative: likely viral, and return to work depends on symptom severity and institutional policies 1

Red Flags Requiring Urgent Reassessment

This patient should be immediately reevaluated if any of the following develop:

• Drooling or difficulty swallowing (suggests peritonsillar abscess or epiglottitis) 7, 8
• Muffled voice (indicates deep space infection) 7, 8
• Trismus (jaw stiffness suggesting peritonsillar abscess) 7, 8
• Neck swelling or severe neck tenderness (concern for Lemierre syndrome or retropharyngeal abscess) 7, 8
• Respiratory distress or stridor 8

If symptoms persist or worsen 48-72 hours after starting antibiotics, reassess for complications or alternative diagnoses 4, 5

Common Pitfalls to Avoid

• Do not prescribe antibiotics empirically in patients with Centor scores of 0-2 without positive testing, as this leads to unnecessary antibiotic use in 60% of adults presenting with sore throat 1, 2
• Do not use shorter antibiotic courses than 10 days for confirmed GAS pharyngitis, as this increases risk of rheumatic fever 1, 4
• Do not use aspirin if the patient were younger (risk of Reye syndrome in children) 1, 4
• Do not routinely culture or treat asymptomatic household contacts unless in an outbreak situation 4