Acute sore throat (pharyngitis, tonsillitis, and laryngitis) in children
These guidelines are based on the guidelines found on the Prodigy web site.
Pharyngitis is inflammation of the oropharynx but not the tonsils
Tonsillitis is usually diagnosed if the tonsils are particularly affected
"Laryngitis" is used if there are few visible signs of infection but the patient complains of soreness lower down the throat, often with a hoarse voice.
Acute sore throat is usually due to a viral infection, often as part of an upper respiratory tract infection / flu-like illness, or due to Epstein-Barr Virus (e.g. in glandular fever).
Group A beta-haemolytic streptococcus (GABHS) is the most common bacterial cause of sore throat. GABHS can be isolated from up to 30% of patients presenting with acute sore throat. However, figures for asymptomatic carriage range from 6% to 40%.
Rheumatic fever and post-streptococcal glomerulonephritis (rare)
Streptococcal toxic shock syndrome
Viral and bacterial sore throat are clinically indistingusihable. Streptococcal infection is likely, if a scarlet fever rash is present.
Throat swabs and rapid antigen tests should not be carried out routinely in sore throat. Streptococcal serology can identify whether a person has recently been infected with streptococcus, and may be useful for people who remain unwell or develop complications.
"Sore throat" (pharyngitis, tonsillitis, laryngitis) is usually a self-limiting condition, whether due to viral or bacterial infection.
Explanation, reassurance, and advice on symptomatic treatment are frequently all that is necessary.
Paracetamol is the analgesic drug of choice in sore throat. Ibuprofen is an alternative.
"Gargles" have been poorly researched. Don't use them in children.
If antibiotics are to be commenced, it is reasonable to take a throat swab.
Antibiotics are recommended in the following situations:
Features of marked systemic upset
High risk groups:
A history of rheumatic fever
Increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency).
The prevention of cross-infection with group A beta-haemolytic streptococcus in closed institutions (such as barracks, boarding schools).
The antibiotic of choice is phenoxymethylpenicillin (amoxicillin is an alternative, but causes a rash with glandular fever).