The patient with a bacterial pharyngitis complains of a rapid onset of throat pain worsened by swallowing. There is usually a fever, pharyngeal erythema, and a purulent, patchy, yellow, gray or white exudate, tender cervical adenopathy, headache and absence of cough. Viral infections are typically accompanied by conjunctivitis, nasal congestion, hoarseness, cough, aphthous ulcers on the soft palate and myalgias. Rapid strep tests may provide results in a few minutes, while cultures may take 1-2 days to incubate and interpret. This delay does not alter the effectiveness of therapy, however.
Throat culture is optional, at the preference of the follow-up physician.
The recommended treatment for streptococcal pharyngitis is oral penicillin VK 250mg q8h for 10 days. Injectable penicillins are preferred for patients unlikely to finish ten days of pills and those with a personal or family history of rheumatic fever. Amoxicillin offers no significant advantage for treating group A strep. If the rapid strep test is positive, then treat with antibiotics as above. Viscous Xylocaine gargles anesthetize the throat but patients may still have difficult swallowing because of the lack of sensation.