Resources/Guidelines

From 2001 (Ann Internal Med) and U Michigan Guidelines

SORE THROAT:
Guidelines Ann Internal Med, U Michigan
All adult patients with pharyngitis should be clinically screened for the presence of the Centor criteria:
-tonsillar exudates,
-tender anterior cervical lymphadenopathy,
-absence of cough
-history of fever.
Yes to 3 or 4 criteria: 40 to 60 percent chance of strep throat.
No to 3 or 4 criteria: only 20 percent chance.
Patients with none or one of these criteria should not be tested or treated.

All patients with pharyngitis should be offered appropriate doses of analgesics, antipyretics and other supportive care.

The preferred antimicrobial agent for treatment of acute pharyngitis is penicillin, or erythromycin for penicillin-allergic patients. There is no evidence of group A beta-hemolytic streptococcus resistance to or tolerance of penicillin, and erythromycin resistance rates are low in the United States.

Treatment: Penicillin 250 mg tid-qid or 500 mg bid for 10 days
Alternative: Erythromycin base 333 tid for 10 days
Other alternative: First-gen cephalosporin

These guidelines do not apply to patients with a history of rheumatic fever, valvular heart disease, immunosuppression, recurrent or chronic pharyngitis, or to patients with sore throats not caused by acute pharyngitis. Also, the guidelines should not be used during a known epidemic of acute rheumatic fever or streptococcal pharyngitis or in nonindustrialized countries in which the endemic rate of acute rheumatic fever is much higher than in the United States.

The goal of treatment of strep throat is prevention of rheumatic heart disease.

SINUS PAIN:
Guidelines
Sinusitis: Less than 7 days is usually viral (>90%). Not recommended to start antibiotics unless symptoms have been present more than 7 days. Amoxicillin still preferred.

COUGH:
Guidelines
Bronchitis: Purulent sputum not indicative of bacterial infection

More likely to be pneumonia if heart rate >100, resp >24, and temp >38 C.

90% of acute uncomplicated bronchitis cases are non-bacterial

Albuterol recommended to shorten duration of cough

-At 7 days, 40-60% of albuterol treated patients were still coughing, versus 90% of control.

-Better than antibiotics in studies!
To get the abstracts, go to www.pubmed.gov and type in 1940815 , or 7864949

GENERAL UPPER RESPIRATORY TRACT INFECTION
Guidelines

Almost never bacterial.