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You must know the FOUR emergent causes of sore throat!

Step 1: Apply the Centor Criteria

  • Determines if patients is at risk for Group A strep (“strep throat”)
  • 4 Criteria
    • Fever
    • No cough
    • Tonsiller exudates
    • Lymphadenopathy
  • Interpretation
    • If patient has ALL of the criteria
      • Treat for strep throat
    • If patient has NONE of the criteria
      • Don’t even test for strep throat
    • If patient has SOME of the criteria
      • Consider testing for strep throat

Step 2: Prescribe Antibiotics

  • B-lactams work best
    • Penicillin
    • Amoxicillin
  • If patient has allergy, consider alternative agent
    • Azithromycin
    • Clindamycin

Step 3: Pain Control

  • NSAIDS
  • Steroids

Step 4: Consider EBV (Epstein-Barr Virus)

  • Consider in patients not getting better on antibiotics
  • Examine for splenomegaly
    • If present, no contact sports

Step 5: Consider the FOUR Emergent Causes of Sore Throat

  • Ludwigs angina
    • Airway emergency
    • Infection UNDER the tongue
  • Peritonsillar abscess (PTA)
    • Complication of bacterial pharyngitis
    • Causes “trismus” (difficulty opening mouth)
    • Frequently need to be drained
  • Retropharyngeal abscess
    • Airway emergency
    • Difficult to diagnose by exam alone
      • Infection is BEHIND airway
      • Seen on lateral neck xray
  • Epiglottitis
    • Airway Emergency
    • “The Triad”
      • Drooling
      • Dysphagia
      • Distress (respiratory)
    • Lateral neck xray shows “thumbprint sign”

Additional Reading

  • Peds O- Oxygen, Airway, and Respiratory Disorders (EM Clerkship)
  • Airway Infectious Disease Emergencies (UNM)