i keep getting a sore throat
Download
Skip this Video
Download Presentation
'I keep getting a sore throat'

Loading in 2 Seconds...

play fullscreen
1 / 19

'I keep getting a sore throat' - PowerPoint PPT Presentation


  • 259 Views
  • Uploaded on

'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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ''I keep getting a sore throat'' - bathsheba


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]
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
ad