Therapies

__//** Therapies **//__

 Patients with GAS pharyngitis, empirical treatment should be done immediately to prevent complications, to reduce the infection and transmissibility, and to induce clinical improvement of symptoms. Patients with a higher level of suspicion of GAS pharyngitis but delayedculture results can also be given empirical antibiotics. Alternatively antibiotics can be withheld until the culture is positive for S pyogenes. Delaying the treatment for GAS doesn't have any effect on rheumatic heart disease or the strain of S pyogenes. The latter will reduce the inappropriate antibiotic usage and control the antibiotic resistance.

 Selecting antibiotic primarily depend on the way it is to be administered, its effect, cost and condition that is not limited the antibiotic. Penicillin V or amoxicillin is used for around ten days. Intramuscular penicillin G benzathine may be administreted in patients who are unable to complete the ten days period. Macrolides like erythromycin, azithromycin are alternatively used in penicillin allergic patients. Absence of penicillin-resistant GAS compels a cheaper alternative than latest antibiotics which are expensive. Penicillin is not able to prevent nasopharyngeal carriage in patients with frequent GAS pharyngitis.  Amoxicillin/clavulanate or rifampin may be used in such patients. Antibiotics should not be used in patients with negative throat RADT/cultures.

 Pharyngitis caused by anaerobic bacteria may respond to penicillins or clindamycin.Yersinia pharyngitis is treated with latest cephalosporin. Mycoplasma pharyngitis is treated by doxycycline or macrolides. Symptomatic oropharyngeal in immunodeficient patients are treated by acyclovir ten days.  Amantadine or neuraminidase inhibitors are used to treat Influenza A pharyngitis if the patient is presented immediately after the start of symptoms. Antiretroviral therapy maybe used for HIV acute retroviral syndrome.  Fluids, gargling with warm and salty water, nonsteroidal anti-inflammatory drugs and rest of voice are some symptomatic relief. Gargling with Chamomile, Blackberry, sage may also help.

 __//** References : **//__


 * Information from your family doctor. Sore throat. American Family Physician. 2006;74:1185.


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 * Seller RH. Differential Diagnosis of Common Complaints. 5th ed. Philadelphia, Pa.: Saunders Elsevier; 2007