Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance

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The goal of this narrative review of pharyngitis is to summarize the practical aspects of the management of sore throat in children in high- and middle-income countries. A traditional review of the literature was performed. Most cases of pharyngitis are viral and self-limited, although rarely viral pharyngitis due to Epstein–Barr leads to airway obstruction. Bacterial pharyngitis is usually due to group A streptococcus (GAS), occurs primarily in children aged 5–15 years, and presents as sore throat in the absence of rhinitis, laryngitis or cough. Again, most cases are self-limited; antibiotics hasten recovery by only 1–2 days. Guidelines vary by country, but antibiotics are commonly recommended for proven GAS pharyngitis as they may prevent rare but severe complications, in particular rheumatic fever (RF). In this era of antimicrobial stewardship, it should be extremely rare that antibiotics are prescribed for presumed GAS pharyngitis until GAS has been detected. Even with proven GAS pharyngitis, it is controversial whether children at low risk for RF should routinely be prescribed antibiotics as the number needed to treat to prevent one case of RF is undoubtedly very large. When treatment is offered, the antibiotics of choice are penicillin or amoxicillin as they are narrow spectrum and resistance resulting in clinical failure is yet to be documented. A 10-day oral course is recommended as shorter courses appear to be less likely to clear carriage of GAS. However, the evidence that one needs to clear carriage to prevent RF is low quality and indirect.

Keywords: group A streptococcus, pharyngitis.

Citation: Robinson JL. Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance. Drugs in Context 2021; 10: 2020-11-6. DOI: 10.7573/dic.2020-11-6

Contributions: The named author meets the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, takes responsibility for the integrity of the work as a whole, and has given her approval for this version to be published.

Disclosure and potential conflicts of interest: The author declares that she has no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at:

Acknowledgements: The author would like to thank Drs Dolores Freire, Alexandra Seal-Grant and Catherine Burton for pre-submission review of this manuscript.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2021 Robinson JL. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Robinson JL. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Joan L Robinson, 4-590 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada. Email:

Provenance: Invited; externally peer reviewed.

Submitted: 24 November 2020; Accepted: 22 February 2021; Publication date: 26 March 2021.

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