SORE THROAT IN CLINICAL PRACTICE :SORE THROAT IN CLINICAL PRACTICE DR ZAFAR SULTANA PRIMARY CARE PHYSICIAN


OBJECTIVE :OBJECTIVE TO BE AWARE OF A RATIONAL APPROACH TO SORE THROAT IN PRACTICE. TO HIGHLIGHT JUDICIOUS USE OF ANTIBIOTICS IN SORE THROAT.


INTRODUCTION :INTRODUCTION HALLMARK : DRY SCRATCHINES THROAT AND PAINFULL SWALLOWING PHARYNGITIS TONSILOPHARYNGITIS INCIDENCE : 10 – 20% OF OUT PATIENTS 6.7 MILLION VISITS PER YEAR IN UK ESTIMATED COST PER ANNUM 60 MILLION POUNDS SIGNIFICANT ECONOMIC AND WORK LOAD IMPACT


ETIOLOGY :ETIOLOGY VIRAL 70% RHINOVIRUS 40% CORONAVIRUS 10 -20% ADENOVIRUS 10% HERPES VIRUS 8% PARAINFLUENZA VIRUS INFLUENZA VIRUS COXSACKIE VIRUS EBSTEIN BARR VIRUS <2% CYTOMEGALOVIRUS <2% HIV <1%


ETIOLOGY :BACTERIAL 20-30% STREPTOCOCCUS, GP A 75 - 90% STREPTOCOCCUS, GP C 5-10 % NEISSERIA GONORRHOEA CORNY DIPTHERIAE ARCANO HAEMOLYTICUS CHLAMYDIA PNEUMONIAE MYCOPLASM PNEUMONIAE Principals & practice of infect dis 2000;656-62 ETIOLOGY


CLINICAL DAIGNOSIS :CLINICAL DAIGNOSIS BACTERIAL FEVER >39 TONSILLAR EXUDATE TENDER ANT CERVICAL NODES NO COUGH CENTOR CRITERIA ( McIsaac ) VIRAL FEVER RHINORHEA MALAISE HEADACHE VOMITING NAUSEA RASH NO ABSOLUTE DEMARCATION CLINICALLY


BACTERIAL SORETHROAT :BACTERIAL SORETHROAT


CLINICAL DAIGNOSIS :CLINICAL DAIGNOSIS


CLINICAL DAIGNOSIS :CLINICAL DAIGNOSIS


LAB DIAGNOSIS :LAB DIAGNOSIS CBC : POLYMORPHONUCLEAR LEUCOCYTOSIS CRP : HIGH SPECIALLY WITH COMPLICATIONS THROAT CULTURE SENSITIVITY 90 – 95 % GOLD STANDERD CONSUME 24 – 48 HOURS INDICATIONS : SERONEGATIVE SORE THROAT SUSPECTED RESISTENCE NEGATIVE CUITURE DOES NOT RULE OUT DIAGNOSIS THROAT SWABS ARE NOT ROUTINELY CARRIED OUT IN SORE THROAT


LAB DAIGNOSIS :LAB DAIGNOSIS RAPID STREP TEST SENSITIVITY : 61 – 95 % SPECIFICITY : 88 – 100 % CONSUMES : 10 MINUTES EASY TO PERFORM. INCREASES NUMBER OF PATIENTS APPROPRIATELY TREATED FOR STREPTOCOCCAL INFECTION. DECREASES MORBIDITY. Negative strep test to be confirmed by conventional culture .


LAB DAIGNOSIS :LAB DAIGNOSIS MONOSPOT TEST INFECTIOUS MONONUCEOSIS : EXUDATIVE , FALSE MEMBRANE ATYPICAL LYMPHOCYTES SUBCLINICAL HEPATITIS SENSITIVITY : 90 %


LAB DIAGNSIS :LAB DIAGNSIS RAPID STREP TEST


COMPLICATIONS :COMPLICATIONS SUPPURATIVE PERITONSILLAR ABCESS ( QUINCY ) COMMON RETROPHARYNGEAL ABCESS NON SUPPURATIVE ACUTE RHEUMATIC FEVER THREE WEEKS 1% OF ALL GBHS SORE THROAT NINE DAYS DELAY IS ACCEPTABLE POST SREPTOCOCCAL GLUMERULONEPHRITIS REACTIVE ARTHRITIS STRIDOR AND RESPIRATORY DISTRESS IS ABSOLUTE INDICATION OF HOSPITALIATION


STREPTOPHOBIA :STREPTOPHOBIA


MANAGEMENT :MANAGEMENT SYMTOMATIC GENERAL MEASURES ADEQUATE FLUIDS WARM GARGLES SIMPLE ANALGESICS / ANTIPYRETICS PARACETOMOL : SAFE & EFFECTIVE NO ASPIRIN NSAIDS IBUPROFEN : USE SPARINGLY THROAT LOZENDES / GARGLES STERIODS ??? DEXAMETHASONE : RAPID ONSET & GREATER DEGREE PAIN RELIEF


IDSA 2002 GUIDELINES :SPECIFIC THERAPY IDSA 2002 GUIDELINES


IDSA 2002 GUIDELINES :IDSA 2002 GUIDELINES ANTIBOITIC SELECTION & DURATION DOSAGE & DURATION TO ERADICATE ORGANISM FROM PHARYNX FIRST LINE : ORAL :PENICILLIN V 250 BD X 10 DAYS INTRAMUSCULAR : BENZATHINE PENICIILLIN ( SINGLE DOSE) 27 KG : 1200,000 IU AMOXICILLIN , FIRST GEN CEPHALOSPORIN ; CEPHALEXIN FOR PENICILLIN ALLERGIC : ERYTHROMYCIN ESTOLATE / ETHENYL SUCCINATE 40 MG/KG/DAY X 10 D SECOND LINE : AMOXY-CLAVULINIC ACID X 10 DAYS CEFUROXIME X 10 DAYS SECOND & THIRD GEN CEPHLOSPORIN CLINDAMICIN X 10 DAYS INFECTIOUS DISEASE SOCAITY OF AMERICA


IDSA 2002 GUIDELINES :BENEFITS OF ANTBIOTICS FOR GABHS PREVENTION OF ACUTE RHEUMATIC FEVER PREVENTION OF SUPPURATIVE COMPLICATIONS IMROVEMENT OF CLINICAL SYMPTOMS AND SIGNS REDUCTION IN TRANSMISION OF GABHS TO CLOSE CONTACTS NATIONAL GUIDELINES CLEARIGHOUSE 1998 - 2005 IDSA 2002 GUIDELINES


SURGICAL TREATMENT :SURGICAL TREATMENT ABSULUTE 1. RECURRENT SORE THROAT MORE THAN 6 EPISODES PER YEAR THREE EPISODES PER YEAR FOR CONSEC TWO YEARS. SORE THROAT AFFECTING DAILY FUNCTIONS IN LIFE


INDICATIONS OF TONSILLECTOMY :INDICATIONS OF TONSILLECTOMY 2. PERMANENT RESPIRATORY TRACT OBSTRUCTION


INDICATIONS OF TONSILLECTOMY :3. PERITONSILLAR ABCESS OR SEPSIS INDICATIONS OF TONSILLECTOMY


INDICATIONS OF TONSILLECTOMY :RELATIVE INDICATION PERMANENT CARRIER STATE INDICATIONS OF TONSILLECTOMY


ALGORHITHM :ALGORHITHM


HOME REMEDIES :HOME REMEDIES INCREASE YOUR FLUID INTAKE : FLUIDS; WATER , JUICE,TEA AND WARM SOUP TO REPLACE FLUID LOSS. AVOID CAFFIENE & ALCOHOL. GARGLE WITH SALT WATER : SOOTHING. USE HONEY & LEMON : HONEY COATS AND SOOTHES THROAT. LEMON HELPS MUCOSAL HEALING. THROAT LOZENGE OR HARD CANDY : STIMULATES SALIVA PRODUCTION WHICH BATHES & CLEANES THROAT


PREVENTION :PREVENTION HAND HYGIENE : ALCOHOL BASED HAND SANITIZER OR SOAP AND WATER AVOID SHARING EATING UTENSILS, FOOD,GLASSES, NAPKINS OR TOWELS AVOID TOUCHING PUBLIC PHONES OR DRINKING FOUNTAINS WITH MOUTH REGULARLY CLEAN TELEPHONES, T.V. REMOTE, COMPUTER KEY BOARD WITH SANITIZING CLEANSER. AVOID ACTIVE & PASSIVE SMOKING. HUMIDIFY YOUR HOME. COUGH OR SNNEZE IN TISSUE & DISPOSE. ON COMMERCIAL PLANE KEEP AIR NOZZLE CLOSED.


MESSAGE :MESSAGE THERE IS NEED OF FORMULATING HOSPITAL BASED GUIDELINE CONSIDERING AVAILABLE LABORTORY RESOUCRCES .