A 10-year-old male presents with a 5-day history of fever and sore throat, currently improving, with no difficulty swallowing, nasal congestion, or cough, and has been treated with over-the-counter (OTC) medications, such as acetaminophen (paracetamol) or ibuprofen, for fever management.

From the Guidelines

The patient should be provided with a school excuse note for the days missed due to fever and sore throat, as the clinical presentation suggests a viral illness that is resolving spontaneously. Based on the clinical presentation, the mother's use of over-the-counter fever reducers like acetaminophen (10-15 mg/kg/dose every 4-6 hours, not exceeding 5 doses in 24 hours) or ibuprofen (10 mg/kg/dose every 6-8 hours with food) was appropriate management, as supported by general pediatric guidelines 1. The child can return to school when fever-free for 24 hours without fever-reducing medications. Since the last documented fever was Wednesday and today's visit is for a school excuse, it appears the child is likely ready to return to school. Adequate hydration should be maintained, and rest encouraged during recovery. The sporadic nature of the sore throat and absence of other symptoms like difficulty swallowing, nasal congestion, or cough suggests this is likely a self-limiting viral pharyngitis rather than streptococcal pharyngitis, which would require antibiotic treatment, as outlined in the clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis 1. If symptoms worsen or new symptoms develop, the patient should return for reevaluation to assess for potential streptococcal pharyngitis, which would necessitate antibiotic treatment with penicillin or amoxicillin for 10 days, as recommended by the Infectious Diseases Society of America 1. Key considerations in the management of streptococcal pharyngitis include the use of narrow-spectrum antibiotics, such as penicillin or amoxicillin, to minimize the risk of antibiotic resistance and promote cost-effectiveness 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Patient Presentation

• The 10-year-old patient presents with a 5-day history of fever and sore throat, with the last documented fever occurring on Wednesday.
• The patient reports that the sore throat is sporadic but is starting to feel better, and denies any difficulty swallowing, nasal congestion, runny nose, or cough.
• The patient's mother has been giving over-the-counter medications to treat the fever.

Diagnostic Considerations

• The patient's symptoms, such as sore throat and fever, are consistent with streptococcal pharyngitis, as described in studies 2, 3, 4, 5, 6.
• The absence of cough, coryza, and diarrhea suggests a bacterial cause, as these symptoms are more commonly associated with viral pharyngitis 2, 3.
• The modified Centor score can be used to predict the risk of Streptococcus pyogenes infection, as mentioned in studies 2, 3, 5.

Treatment Options

• Penicillins are the first-choice treatment for streptococcal pharyngitis, as recommended in studies 2, 3, 5, 6.
• For patients with penicillin allergy, cephalosporins or macrolides can be used as alternative treatments, as suggested in studies 2, 3, 5, 6.
• The use of antibiotics should be guided by clinical decision rules and rapid antigen testing to minimize unnecessary use, as recommended in studies 4, 6.

Additional Considerations

• The patient's age and symptoms, such as tender anterior cervical adenopathy and tonsillar exudates, can increase the clinical suspicion of streptococcal pharyngitis, as mentioned in studies 3, 5, 6.
• Tonsillectomy is rarely recommended as a preventive measure, and is typically considered only in cases of recurrent streptococcal pharyngitis, as mentioned in study 6.