The primary concern for pharyngitis in children aged two years or older is that untreated Group A beta-haemolytic streptococcal (GABHS) pharyngitis may subsequently cause rheumatic fever. To prevent this sequela, institute adequate antimicrobial therapy within nine days of infection.
Rapid antigen detection assays for GABHS are diagnostic if positive. Other bacteria that occasionally cause pharyngitis and require antimicrobial therapy include gonococcus; Francisella tularensis; groups B, C, and G streptococci; Arcanobacterium hemolyticum; and Treponema pallidum. No treatment is of any benefit for the usual viral causes of pharyngitis.
Multiple entities can cause irritation and inflammation of the pharynx. In children, such causes range from viruses (adenoviruses, enteroviruses, and Epstein-Barr virus), which often require only supportive therapy, to bacterial pathogens (GABHS), which require antibiotic therapy. For all cases of pediatric pharyngitis, whether of bacterial or viral origin, supportive care is necessary to prevent associated symptoms such as dehydration.
Primary bacterial pathogens account for approximately 30% of cases of pharyngitis in children. These include the following:
- GABHS (common)
- Arcanobacterium hemolyticum (7% of adolescents and adults with pharyngitis)
- Group C streptococci (uncommon)
- Group G streptococci (uncommon)
- Neisseria gonorrhoeae (uncommon)
- Corynebacterium diphtheriae (rare).
GABHS pharyngitis is spread via respiratory droplets through close contact. It has an incubation period of 2-5 days. For all types of pharyngitis, the prognosis is excellent. Streptococcal pharyngitis has a 5-7-day course, and symptoms usually resolve spontaneously, without treatment. However, in rare cases, rheumatic fever can develop if GABHS is left untreated. Rarely, peritonsillar abscesses or other local complications develop; these may call for surgical intervention. With supportive care to prevent dehydration and pain, pharyngitis, for the most part, is a self-limiting disease.
Pharyngitis is a leading cause of paediatric ambulatory care visits. Examination of patients who present with sore throat may reveal tonsillitis, tonsillopharyngitis, or nasopharyngitis. For all types of pharyngitis, the prognosis is excellent. Streptococcal pharyngitis has a 5-7-day course, and symptoms usually resolve spontaneously, without treatment.
Doctors should emphasise the importance of the patients completing a full course of antibiotics, regardless of symptom response. Instruct families to encourage adequate hydration and to use antipyretics for pain and fever.
In addition, instruct parents to seek immediate medical care or consult their primary medical provider if signs of dehydration occur or symptoms worsen.