Sore Throat Pathway - Take a Throat Swab & Consider starting empirical Antibiotics
- Take a throat swab and start empirical antibiotics if follow up of throat swab result cannot be guaranteed. A back-pocket script could be considered for selected patients. Note to ensure Rheumatic Fever prevention group A streptococcal pharyngitis treatment should commence as soon as possible after diagnosis,ideally within 5 days. It is no longer safe to wait up to 9 days from symptoms onset to treat as was previously recommended. In this high risk group the greatest benefit is obtained by having a low threshold for prescribing antibiotics.
- For children with severe recurrent tonsillitis, tonsillectomy does offer benefit, by reducing the number of sore throats in the short term (12 months). As a guide, 7 episodes in the preceding 12 months, or 5 in each year for 24 months, or 3 per year for 3 years may warrant consideration, taking account of the clinical severity of episodes (see page 44 of Guidelines).
- There is insufficient data to make a definitive recommendation on the use of tonsillectomy in treating recurrent GAS pharyngitis (see page 45 of Guidelines).
Reference: New Zealand Guidelines for Rheumatic Fever; 2014 Update; pg27
If prevention of ARF is the prime consideration, is it safe to wait for up to nine days, from the onset of GAS pharyngitis, before commencing antibiotics?
It is not safe to wait up to nine days, from GAS pharyngitis onset to commencing antibiotics. Early studies of the aetiology of ARF recommended that GAS sore throats be treated within nine days of onset of symptoms. There is a latent period following GAS infection before the symptoms of ARF begin. However one intervention study, a randomised control trial (RCT) and an observational study documented cases of ARF developing within nine days of the first onset of GAS pharyngitis. The so-called "nine day rule" is quoted for the management of GAS pharyngitis in children in America where ARF is now uncommon. Timely treatment of streptococcal pharyngitis with penicillin is necessary to prevent the subsequent development of ARF.
Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016
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