ENT  |  Sore Throat Pathway - Complete antibiotics




ENT

Sore Throat Pathway - Complete antibiotics

  • Reinforce the message regarding importance of completing antibiotic course when giving the swab result.
  • Note it is not necessary to take a post treatment swab.
  • Should the result identify a Group C and /or G streptococcal sore throat the decision to treat or not should be based on the severity of the symptoms or considered if the patient is a food handler.


Reference New Zealand Guidelines for Rheumatic Fever; 2014 Update; pg43.

Should throat swabs be repeated after antibiotic course has ceased?

This Clinical Question has not been updated from the 2008 Guideline.

A follow-up throat swab following an adequate course of treatment for GAS pharyngitis is not usually recommended. End of treatment swabbing is recommended in the following specific circumstances where the risk of ARF is greatest and therefore treatment of possible re-infection or carriage either in the index case or contacts can be justified:

The IDSA119 recommends the following patients in special situations be routinely swabbed after completing their antibiotic courses for GAS pharyngitis:

  • Those with a history of ARF.
  • Those who develop GAS pharyngitis during outbreaks of ARF or post streptococcal glomerulonephritis (APSGN). Outbreaks of ARF are very unusual 203,204 but outbreaks of APSGN are more common. They should be controlled if possible by controlling the spread of GAS.
  • Those who develop GAS pharyngitis during outbreaks in a closed or partially closed community e.g. boarding school, military barracks, prison.
  • Where there is recurrent GAS pharyngitis within families (IDSA evidence level B-III).

The majority of asymptomatic patients who continue to have positive swabs post-antibiotic treatment are carriers.


Reference New Zealand Guidelines for Rheumatic Fever; 2014 Update; pg50.

Should Group C and/or G streptococcal sore throats be treated with antibiotics?

Both group C and G streptococci can cause self-limiting pharyngitis. The clinical presentation can resemble group A streptococcal pharyngitis. Neither group C or G streptococcal pharyngitis have been associated with subsequent ARF. There have however been published reports of outbreaks of pharyngitis traced to food handlers. The decision to treat group C or G pharyngitis should be based on the severity of symptoms or if the patient is a food handler.



Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016


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