5-10 years old

VERY RARE under age 3 (probably viral)

1. viral- adeno, entero, EBV
2. allergies- PND
3. neisseria gonorrhoeae
4. staph aureus
5. chlamydia trachomatis
6. H. flu

• odynophagia
• dysphagia
• sudden onset fever (>38.5C)
• HEADACHE
• ABDOMINAL PAIN
• lymphadenopathy
• hx of exposure

KEY NEGATIVE FINDINGS: absence of cough, congestion, rhinorrhea

• petechiae on the palate
• enlarge, erythematous tonsils
• exudate
• high fever
• cervical adenopathy
• no sneezing, rhinorrhea, nasal congestion, cough
• no vesicles, ulcers
• look for abscess and dehydration

• uvula midline
• size of tonsils (red, exudative)
• palate characteristics

Rapid strep (70-90% sensitive for GABHS in children)

Culture if rapid strep negative - GOLD STANDARD

Throat culture grows anything in the throat

Strep screen only looks for strep

to prevent sequelae-the sx will resolve on their own, self-limited

*RHEUMATIC FEVER- autoimmune response secondary to molecular mimicry, MUST TX GABHS W/I 9 DAYS!!!! - UPPER respiratory GABHS only!

*POST STREPTOCOCCAL GN- edema, gross hematuria, proteinura, HTN; pea "iced'tea" colored urine- UPPER and SKIN GABHS

• if considering EBV/mono-->CBC for atypical lymphocytosis, monospot, maybe LFTs if RUQ tenderness
• 30% positive rapid strep with mono
• if have mono and rx amoxicillin-->RASH!

1. PCN VK = textbook drug of choice (<12-250mg BID x 10d; >12-500mg BID x 10d)
2. **AMOXICILLIN 40mg/kg in children; adults 500mg TID
3. allergy to PCN = Zithromax 12mg/kd x 5 days, 2nd gen cephalosporins, clindamycin
4. DO NOT USE BACTRIM/SEPTRA (doesn't prevent rheumatic fever)

sudden onset of odynophagia, headache, positive ill contacts with GABHS, but absence of cough and congestion.

can have vomitting and abdominal pain

acetaminophen 10-15 mg/kg q4-6 hours, max 4g/day

ibuprofen 5-10 mg/kg q6-8 hours, max 2.4g/day

1. augmentin (amox/clav)
2. keflex (cephalexin)
3. omnicef (cefdinir)
4. clindamycin (cleocin)
5. ceftin (cefuroxime)
6. PCN G IM

• 20% of asymptomatic children are chronic carriers
• no routine cultures

• try clindamycin or augmentin
• may consider IM benzathine PCN +/- rifampin

unusual situation