If I were writing sore throat guidelines

Several tweets asked me to answer this question. How would I rewrite sore throat guidelines? Obviously I am biased. So this is my opinion and I am sticking to it! I would not change anything about pre-adolescents. Group A strep is the most important bacterial infection and using rapid tests with backup cultures makes sense.I would change the guidelines for adolescents and young adults. I would treat patients having Centor scores of 3 or 4 with either penicillin or amoxicillin (augmentin would be fine). I would probably treat some 2s if they looked very ill. I would never use macrolides. If the patient is truly penicillin allergic and looked sick then I would use clindamycin.I would have a printed sheet for all adolescent/young adults. I will do a mockup of that sheet in the next paragraph.Patients over 30 rarely have pharyngitis. I would treat those patients similarly to adolescent/young adults if they looked sick. Instructions for adolescents and young adults: Sore throats should improve over 3-5 days with or without antibiotics. If your sore throat worsens, please return for repeat evaluation. Beware of the following signs of serious infection: Rigors – shaking chillsDrenching night sweatsWorsening sore throat Unilateral neck swellingShortness of breath If you have any of those signs you will likely need intravenous antibiotics, so you should go to an emergency department as soon as possible. Commentary Most Fusobacterium necrophorum do respond...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs