Table 1: coMMon causes of phaRyngITIs

Bacteria Streptococcus pyogenes group C and G beta hemolytic streptococci Arcanobacterium haemolyticum Yersinia enterocolitica anaerobic infection (Vincents angina) Mycoplasma pneumoniae Chlamydophila pneumoniae Neisseria gonorrhoeae Corynebacterium diphtheria Viruses rhinoviruses coronaviruses parainfluenza viruses adenoviruses influenza viruses A and B herpes simplex type I (rarely type II) coxsackie viruses Epstein-Barr virus

Table 2: McIsaac DecIsIon Rule

Criteria temperature > 38 C no cough tender anterior cervical adenopathy tonsillar swelling or exudates age 3-14 years age 15-44 years age 45 years total score
Adapted from: McIsaac WJ et al. CMAJ 2000;163:811-5.

Points 1 1 1 1 1 0 -1

Table 3: McIsaac DecIsIon Rule scoRes anD The coRResponDIng pRopoRTIon of paTIenTs In whoM S. pyogeneS can be IsolaTeD
McIsaac score 0 1 2 3 4 % with S. pyogenes 2-3 4-6 10-12 27-28 38-63

May vary by season and the relative prevalence of respiratory pathogens. Adapted from: McIsaac WJ et al. CMAJ 2000;163:811-5.

fIguRe 1: woRkup of phaRyngITIs

Pharyngitis Apply McIsaac Decision Rule Score 1 2-6% GAS* Score 2-3 10-28% GAS Score 4-5 39-63% GAS

Unlikely GAS

Antigen testing, Culture

Severity? Logistics? Patient preference?

Patient counselling Symptom relief

Negative

Positive Penicillin allergic?

Patient counselling Symptom relief Consider alternatives

No

Yes

Penicillin or Amoxicillin 10 d Yes Cephalosporins Short course * GAS = Group A beta-hemolytic streptococci

Immediate hypersensitivity? No Macrolides Short course