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te pharyngitis
Treatment
– T reat fev er and pain in all cases (paracetam ol P O , pag e 2 6 )
– V iral ph aryng itis is usually a self-lim ited illness. Spontaneous resolution typically
occurs w ith in a few d ays (or w eeks, for IM ): no antibiotic th erapy.
– C h oice of antibiotic treatm ent for streptococcal ph aryng itis:
• I f sing le-use injection equipm ent is av ailable, benzath ine benzylpenicillin is th e
d rug of ch oice as streptococcus A resistance to penicillin rem ains rare; it is th e only
antibiotic prov en effectiv e in red ucing th e incid ence of rh eum atic fev er; and th e
treatm ent is ad m inistered as a sing le d ose.
benzathine benzylpenicilin I M
C h ild ren und er 6 years: 6 0 0 0 0 0 I U as a sing le d ose
C h ild ren ov er 6 years and ad ults: 1 .2 M I U as a sing le d ose
• P enicillin V is th e oral reference treatm ent, but poor ad h erence is pred ictable d ue to
th e leng th of treatm ent.
phenoxymethylpenicilin (penicillin V) P O for 1 0 d ays
C h ild ren und er 1 year: 2 5 0 m g / d ay in 2 d iv id ed d oses
C h ild ren from 1 to 5 years: 5 0 0 m g / d ay in 2 d iv id ed d oses
C h ild ren from 6 to 1 2 years: 1 g / d ay in 2 d iv id ed d oses
A d ults: 2 g / d ay in 2 d iv id ed d oses
• A m oxicillin is an alternativ e and th e treatm ent h as th e ad v antag e of being
relativ ely sh ort. H ow ev er, it can cause ad v erse skin reactions in patients w ith
und iag nosed IM and th us sh ould be av oid ed w h en IM h as not been exclud ed .
amoxicillin P O for 6 d ays
C h ild ren: 5 0 m g / kg / d ay in 2 d iv id ed d oses
A d ults: 2 g / d ay in 2 d iv id ed d oses
• R esistance to m acrolid es is frequent, eryth rom ycin and azith rom ycin sh ould be
reserv ed for penicillin allerg ic patients. P oor ad h erence w ith eryth rom ycin is
pred ictable d ue to th e leng th of treatm ent. A zith rom ycin treatm ent h as th e
ad v antag e of being sh ort.
erythromycin P O for 1 0 d ays
C h ild ren: 3 0 to 5 0 m g / kg / d ay in 2 to 3 d iv id ed d oses
A d ults: 2 to 3 g / d ay in 2 to 3 d iv id ed d oses
or
azithromycin P O for 3 d ays
C h ild ren: 2 0 m g / kg once d aily
A d ults: 5 0 0 m g once d aily
– G onococcal or syph ilitic ph aryng itis: sam e treatm ent as for g enital g onorrh oea and
syph ilis
– D iph th erial ph aryng itis: see diphtheria, pag e 5 5
– V incent tonsillitis: penicillin V or eryth rom ycin as abov e
– P eritonsillar abscess: refer for surg ical d rainag e
54
Treatment
– T reat fev er and pain in all cases (paracetam ol P O , pag e 2 6 )
– V iral ph aryng itis is usually a self-lim ited illness. Spontaneous resolution typically
occurs w ith in a few d ays (or w eeks, for IM ): no antibiotic th erapy.
– C h oice of antibiotic treatm ent for streptococcal ph aryng itis:
• I f sing le-use injection equipm ent is av ailable, benzath ine benzylpenicillin is th e
d rug of ch oice as streptococcus A resistance to penicillin rem ains rare; it is th e only
antibiotic prov en effectiv e in red ucing th e incid ence of rh eum atic fev er; and th e
treatm ent is ad m inistered as a sing le d ose.
benzathine benzylpenicilin I M
C h ild ren und er 6 years: 6 0 0 0 0 0 I U as a sing le d ose
C h ild ren ov er 6 years and ad ults: 1 .2 M I U as a sing le d ose
• P enicillin V is th e oral reference treatm ent, but poor ad h erence is pred ictable d ue to
th e leng th of treatm ent.
phenoxymethylpenicilin (penicillin V) P O for 1 0 d ays
C h ild ren und er 1 year: 2 5 0 m g / d ay in 2 d iv id ed d oses
C h ild ren from 1 to 5 years: 5 0 0 m g / d ay in 2 d iv id ed d oses
C h ild ren from 6 to 1 2 years: 1 g / d ay in 2 d iv id ed d oses
A d ults: 2 g / d ay in 2 d iv id ed d oses
• A m oxicillin is an alternativ e and th e treatm ent h as th e ad v antag e of being
relativ ely sh ort. H ow ev er, it can cause ad v erse skin reactions in patients w ith
und iag nosed IM and th us sh ould be av oid ed w h en IM h as not been exclud ed .
amoxicillin P O for 6 d ays
C h ild ren: 5 0 m g / kg / d ay in 2 d iv id ed d oses
A d ults: 2 g / d ay in 2 d iv id ed d oses
• R esistance to m acrolid es is frequent, eryth rom ycin and azith rom ycin sh ould be
reserv ed for penicillin allerg ic patients. P oor ad h erence w ith eryth rom ycin is
pred ictable d ue to th e leng th of treatm ent. A zith rom ycin treatm ent h as th e
ad v antag e of being sh ort.
erythromycin P O for 1 0 d ays
C h ild ren: 3 0 to 5 0 m g / kg / d ay in 2 to 3 d iv id ed d oses
A d ults: 2 to 3 g / d ay in 2 to 3 d iv id ed d oses
or
azithromycin P O for 3 d ays
C h ild ren: 2 0 m g / kg once d aily
A d ults: 5 0 0 m g once d aily
– G onococcal or syph ilitic ph aryng itis: sam e treatm ent as for g enital g onorrh oea and
syph ilis
– D iph th erial ph aryng itis: see diphtheria, pag e 5 5
– V incent tonsillitis: penicillin V or eryth rom ycin as abov e
– P eritonsillar abscess: refer for surg ical d rainag e
54
