Paediatric sore throat

INTRODUCTION

• 15-30% Group A strep
  • Peak incidence 3-15yo
• Populations at high risk of ARF should all receive antibiotics and culture confirmation
  • ATSI, maori, Pacific islanders, previous ARF

DDX

• Viral pharyngitis
• Bacterial pharyngitis
• Tonsillitis
• Epiglottitis
• Bacterial tracheitis
• Retropharyngeal abscess
• Peritonsilar abscess
• Herpangina

MANAGEMENT OF SORE THROAT

• Antibiotics if indicated
• Analgesia
  • Oral paracetamol/ibuprofen
  • Oral xylocaine viscous
  • Dexamethasone 0.15mg/kg PO/IV/IM or prednisolone
• When to admit
  • Suspected upper airway obstruction
  • Systemically unwell
  • Evidence of complications e.g. quinsy
  • Significant comorbidity
  • Not tolerating oral fluids

ANTIBIOTICS

• PenV 250mg BD for 10 days (<10yo) or 500mg BD for 10 days (>10yo)
• Cephalexin is second-line
• Roxithromycin if beta-lactam allergic
• Benzathine penicillin G IM or IV benzylpenicillin if not tolerating oral

PERITONSILAR ABSCESS

• Hot potato voice
• Often unilateral severe sore throat
• Drooling
• Trismus
• Neck swelling
• Referred ear pain
• Rx
  • BenPen + Metronidazole
  • Refer to ENT for drainage

INFECTIOUS MONONUCLEOSIS

• Fever, protracted illness, cervical lymphadenopathy (often posterior), fatigue, malaise, hepatosplenomegaly and amoxycillin rash
• Rx as for sore throat
• No evidence for steroids
• Monospot
  • Rapid slide agglutination test for heterophil antibodies
  • Sensitivity varies with patient age
  • Does not actually confirm EBV itself
  • Often falsely negative <4yo
  • Low sensitivity early in infection
  • Specificity 100%

EPIGLOTTITIS/BACTERIAL TRACHEITIS

• Abrupt onset, toxic, absent cough with low-pitched stridor, muffled/hoarse voice, tripod/sniffing position, drooling
• Maintain position of comfort
• Defer examination/IV/imaging
  • Lateral neck X-ray may show epiglottic thickening = thumb sign
• Early PICU/anaesthetic review
• Ceftriaxone IV 50mg/kg BD

RETROPHARYNGEAL ABSCESS

• Most common in children and may present like epiglottitis
• Respiratory distress/stridor
• Dysphagia, odynophagia, drooling
• Torticollis, muffled voice, neck mass, trismus
• Chest pain
• Lateral neck x-ray may show pre-vertebral thickening
  • >7mm at C2
  • >2mm at C6
• Rx
  • CT with contrast is modality of choice
  • Timentin 50mg/kg q6h
  • Refer to ENT for drainage

LATERAL PHARYNGEAL ABSCESS

• Trismus and swelling beneath mandible
• Respiratory distress/stridor
• Torticollis
• Dysphagia, odynophagia, drooling
• Muffled voice
• Same Rx as for retropharyngeal abscess

HERPANGINA – COXSACKIE A16

Last Updated on November 20, 2021 by Andrew Crofton