I keep getting a sore throat
This presentation is the property of its rightful owner.
Sponsored Links
1 / 19

'I keep getting a sore throat' PowerPoint PPT Presentation


  • 208 Views
  • Uploaded on
  • Presentation posted in: General

'I keep getting a sore throat' . 50 year old male smoker Dr K. Sore Throats. Very common presentation Sore throats are self-limiting conditions 50% improve in 3 days [1d] 85% of people resolve in one week [3] Caused by viruses, bacteria and other factors

Download Presentation

'I keep getting a sore throat'

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


I keep getting a sore throat

'I keep getting a sore throat'

50 year old male smoker

Dr K


Sore throats

Sore Throats

  • Very common presentation

  • Sore throats are self-limiting conditions

    • 50% improve in 3 days [1d]

    • 85% of people resolve in one week [3]

  • Caused by viruses, bacteria and other factors

  • Important because might be streptococcal infection

    • Why? Potentially serious complications

    • Case History

  • Pressure to prescribe common to other conditions

    • viral URTI, D&V, otitis media, sinusitis, flu

    • Any actual evidence of benefit?


Gp consultation

GP Consultation

  • Presentation

  • History

  • Examination

  • Diagnosis

    • Viral, viral, viral

  • Supportive

    • ?Antibiotics

  • PUNS & ICE


Presentation

Sore throat

Otalgia

Headache and malaise

Pyrexia

Enlarged tonsils

Pus

Pharyngeal mucosa is inflamed

Foetor

Tender cervical lymphadenopathy

Presentation


History

History

  • Duration of symptoms

  • Systemic features (e.g. fever, malaise)

  • Rash

  • ±Dysphagia

  • ±Trismus


Examination

Examination

  • Adults: Throat only

  • Children: Ears and throat

  • Temp

  • Erythema

  • Tonsil enlargement ± pus

  • Foetor

  • Cervical lymph nodes


Centor criteria

Centor Criteria

  • Fever

  • Absence of cough

  • Cervical lymph nodes (anterior and tender)

  • Exudate on tonsils

  • Positive: 3 out of 4

    • Probability of GABHS 40 - 60%

  • Negative: 3 out of 4

    • Probability not GABHS 80%


Pun ice

PUN & ICE

  • “Most patients don’t come with a sore throat so find out why they came”

  • What do you expect me to do for you?

  • What is it that concerns you?

  • Why do you think an antibiotic will help?


Aetiology acute

Aetiology: Acute

  • Viral

    • Adenoviruses

    • Coxsachie

    • Rhinoviruses

    • Parainfluenzae

    • (10-20%) [1a]

  • Bacteria

    • Group A beta-haemolytic streptoccocus 17%

    • Group B,C, and D streptococci 4%

    • Other (H. influenzae or S. aureus) 1%

  • Other

    • Tuberculosis

    • Candidiasis

    • Chemical irritation


Aetiology chronic

Aetiology: Chronic

  • Smoking

  • Irritation

  • Poor inhaler technique

  • Dust

  • Chemicals

  • Allergy

  • Candidiasis

  • Glandular Fever


Streptococcal infections

Streptococcal Infections

  • Gram-positive cocci

  • Classification:

    • Lancefield grouping: at least 6 (A, B, C, D, F, G)

    • By degree of haemolysis: alpha, beta, non-haemolytic

  • Asymptomatic carriage of GABHS is common, occuring in 6-40% of people [1b]

  • Risk of serious complications

    • Does not predispose to increased risk of serious complications (which are rare)

  • The Centor criteria helps predict those who may benefit from antibiotics


Gahbs complications

GAHBS Complications

  • Otitis media and sinusitis

  • Glomerulonephritis

  • Erysipelas

  • Meningitis

  • Cellulitis

  • Lymphangitis / lymphadenitis

  • Pneumonia

  • Septicaemia

  • Toxic shock syndrome


Management

Management

  • Supportive:

    • Advice and reassurance

    • Analgesics

    • Adequate fluid intake

  • Antibiotics:

    • Pressure from patients to prescribe antibiotics

    • Patients given antibiotics are more likely to re-attend if they have another similar infection

    • Some doctors give a delayed script for use if symptoms are not resolving or getting worse 

    • When to prescribe, which antibiotic and what’s the evidence?


Antibiotics

Antibiotics

Which?

  • Ampicillin

    • Contraindicated: causes a diffuse maculopapular rash in glandular fever

  • Penicillin V 500mg QDS for 10 days

  • Erythromycin 500mg BD/ 250mg QDS for 10 days if allergic [1]

  • Clarithromycin 250-500mg BD for 10 days if allergic [4]

    When?

  • Centor criteria 3 out of 4

  • O/E: red, inflamed, enlarged tonsils with pus

  • Systemically unwell


Antibiotics evidence

Antibiotics: Evidence?

  • 7 day course resolves symptoms 0.5 to 1 days earlier than 3 day course in streptococcal sore throat (651 patient trial)

  • Accelerates resolution by:

    • 2.5 days in patients with group A streptococcal sore throat

    • 1.5 days in non-group A streptococcal sore throat

  • 7 days protective against risk of abscess

  • Trend for protection against acute glomerulonephritis

  • Reduced acute otitis media to 25%

    • You need to treat 30 children to 145 adults to prevent one case of otitis media [4]


Referral

Referral

  • Quinsy

  • Acute upper airways obstruction (inc acute epiglotittis)

  • Dysphagia with systemic upset

  • Hx of sleep apnoea, daytime somnolence or failure to thrive

  • >4 acute episodes in past year and affecting child's normal behaviour

  • Guttate psoirasis exacerbated by recurrent tonsillitis

  • Suspicion of a serious underlying disorder (e.g. leukaemia)


Tonsillectomy

Tonsillectomy

  • Opinions on this subject differ:Indications for tonsillectomy include:

  • More than 5 episodes of tonsillitis requiring antibiotics in a year (not just simply tonsillitis) [2]

  • Recurrent episodes of acute tonsillitis:

    • 3 or 4 attacks in 1 year [1a]

    • 5 attacks in 2 years [1a]

  • Recurrent tonsillitis with complications [1a]

  • Tonsillar or adenoidal hypertrophy causing airways obstruction [1a]

  • One or more episodes of quinsy [1a]

    • It is not indicated after one episode of qunisy since the chance of a recurrence of quinsy is only about 10%. [2]


I keep getting a sore throat

  • As most patients with a sore throat do not see a doctor it is worth asking why they came. [1]


Sources

Sources

  • GP Notebook 2008

    • Tonsillectomy, GP Notebook, 2008

  • Onexamination.com, 2008

  • MeReC Bulletin 2006;17(3):12-14

  • Management of Infection & Infestations, LHB, December 2008


  • Login