Remote Primary Health Care Manuals

Sore throat

             

  • Pharyngitis or tonsillitis (sore throats) can be from viral or bacterial infection — can’t tell which by looking
  • Group A Streptococcus (GAS) is a common cause and highly contagious
  • Treating sore throats in at-risk groups is important to prevent ARF, RHD and kidney failure

At risk groups

  • People aged 2–25 years in Aboriginal communities
  • Anyone with existing RHD or history of ARF
  • Risk groups are always given antibiotics for sore throat — even if it doesn’t look red. Other people are treated based on their symptoms

Prevention of Acute Rheumatic Fever (ARF)

To prevent ARF person must be given either

  • Benzathine benzylpenicillin (Bicillin L-A) single dose (long-acting)
  • OR full course of oral antibiotics
Red Flags — Urgent medical consult 
  • Stridor (noisy breathing) or problems breathing
  • Unable to swallow saliva

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • Head-to-toe exam — with attention to
    • Red throat with enlarged tonsils or pus on tonsils
    • Swollen glands in neck

Do

  • Give benzathine benzylpenicillin*  (Bicillin L-A) IM — adult 1,200,000 units/2.3mL (900mg), child — doses — single dose

* If benzathine benzylpenicillin injection has been given in last 7 days — medical consult — patients already given benzathine benzylpenicillin as RHD prophylaxis still need active treatment of sore throats or skin sores  

    • OR if injection not possible — give phenoxymethylpenicillin oral — adult 500mg, child 15mg/kg/dose up to 500mg — doses — twice a day (bd) for 10 days
  • Note — Very few people remember to take oral antibiotics for 10 days — think carefully before offering phenoxymethylpenicillin
    • Can give 5 day supply then re-dispense to encourage contact with patient
  • If allergy to penicillin — give cefalexin oral — adult 1g, child 25mg/kg/dose up to 1g — doses — twice a day (bd) for 10 days
    • OR give azithromycin oral — adult 500mg, child 12mg/kg/dose up to 500mg — doses — once a day for 5 days
  • Give pain relief if needed 
  • Tell person to
    • Gargle with salt water or dissolved aspirin  — do not use aspirin for child under 12 years
    • Drink lots of fluids 
    • Stay at home, away from others and do not share bedroom for 24 hours after starting antibiotic — to reduce spread to others