Centor Criteria (Signs & Symptoms)

Tonsillar exudates
Tender anterior cervical Lymphadenopathy
Absence of cough
History of fever

In cases of <2 Centor clinical criteria testing should usually not be undertaken. Treatment for Viral Pharyngitis is recommended.

Patient education:

90% of pharyngitis is viral in origin
Antibiotics benefit only the 10% of cases caused by Group A beta-hemolytic streptococcus
Be rechecked if symptoms evolve or worsen

Symptomatic treatment

Avoid cigarette smoke
Gargle with dilute salt water
Acetaminophen or ibuprofen as needed for fever or pain
Throat lozenges (age-appropriate)
Hydration-drink plenty of liquids
Adequate rest

In cases of 2-4 Centor clinical criteria being present, but a negative rapid streptococcal antigen test; a confirmatory throat culture should be obtained.*

Treatment for Viral Pharyngitis is recommended.

Patient education:

90% of pharyngitis is viral in origin
Antibiotics benefit only the 10% of cases caused by Group A beta-hemolytic streptococcus
Be rechecked if symptoms evolve or worsen

Symptomatic treatment

Avoid cigarette smoke
Gargle with dilute salt water
Acetaminophen or ibuprofen as needed for fever or pain
Throat lozenges (age-appropriate)
Hydration-drink plenty of liquids
Adequate rest

* A confirmatory throat culture is not necessary in the case of the practitioner having determined that their rapid streptococcal antigen testing has historically been comparable to throat culture in their practice

In cases of 2-4 Centor clinical criteria being present, but a negative rapid streptococcal antigen test, treatment for Viral Pharyngitis is recommended.

Patient education:

90% of pharyngitis is viral in origin
Antibiotics benefit only the 10% of cases caused by Group A beta-hemolytic streptococcus
Be rechecked if symptoms evolve or worsen

Symptomatic treatment

Avoid cigarette smoke
Gargle with dilute salt water
Acetaminophen or ibuprofen as needed for fever or pain
Throat lozenges (age-appropriate)
Hydration-drink plenty of liquids
Adequate rest

Note:

In adults, a confirmatory throat culture is generally not indicated due to the lower incidence of GABHS infection and lower risk of rheumatic fever. A negative rapid streptococcal antigen test is generally sufficient.

Children <12 years who are not penicillin allergic should receive one of the following:

Benzathine Penicillin 25,000 Units/kg IM (maximum 1.2 million units) x 1 dose
Penicillin V 45 mg/kg/day, divided BID/TID (maximum 500 mg/dose) x 10 days
Amoxicillin 45 mg/kg/day, divided BID/TID (maximum 500 mg/dose) x 10 days

Notes

Macrolide and Cephalosporin treatment should be discouraged as initial therapy in patients not allergic to penicillins
Children with streptococcal pharyngitis should not return to school or child care during the first 24 hours after beginning antibiotics
Follow-up throat culture is not routinely recommended

Children 12-17 years who are not penicillin allergic should receive one of the following:

Benzathine Penicillin 1.2 million units IM x 1 dose
Penicillin V 500 mg PO BID or TID x 10 days
Amoxicillin 500 mg PO BID or TID x 10 days

Notes

Macrolide and Cephalosporin treatment should be discouraged as initial therapy in patients not allergic to penicillins
Children with streptococcal pharyngitis should not return to school or child care during the first 24 hours after beginning antibiotics
Follow-up throat culture is not routinely recommended

Adults who are not penicillin allergic should receive one of the following:

Benzathine Penicillin 1.2 million units IM x 1 dose
Penicillin V 500 mg PO BID x 10 days
Amoxicillin 500 mg PO BID x 10 days

Notes

Macrolide and Cephalosporin treatment should be discouraged as initial therapy in patients not allergic to penicillins
Follow-up throat culture is not routinely recommended

Adults and children who have penicillin allergy and live in an area where there is not known macrolide resistant GABHS should receive macrolide therapy.

Children (choose 1 of the following):

Erythromycin 30-50 mg/kg/day, PO divided TID/QID (maximum 500 mg/dose) x 10 days
Azithromycin (Zithromax®) 12 mg/kg/day, PO given QD (maximum 500 mg/day) x 5 days
Clarithromycin (Biaxin®) 15 mg/kg/day, PO divided BID (maximum 500 mg/day) x 10 days

Adults (choose 1 of the following):

Erythromycin 333-500 mg PO TID/QID x 10 days
Azithromycin (Zithromax®) 500 mg PO QD x 5 days
Clarithromycin (Biaxin®) 250 mg PO BID x 10 days

Notes

Children with streptococcal pharyngitis should not return to school or child care during the first 24 hours after beginning antibiotics
If patient is allergic to macrolides, cephalosporins (in those with mild PCN allergy) or clindamycin (those with severe PCN allergy) can be utilized
Follow-up throat culture is not routinely recommended

Adults and children who have mild penicillin allergy and live in an area where there is known macrolide resistant GABHS should receive cephalosporin therapy.

Children (choose 1 of the following):

Cephalexin (Keflex®) 25-50 mg/kg/day, PO divided BID (maximum 1000 mg/day) x 10 days
Cefadroxil (Duricef®) 30 mg/kg/day, PO divided QD/BID (maximum 1000 mg/day) x 10 days
Cefprozil (Cefzil®) 15 mg/kg/day, PO divided BID (maximum 1000 mg/day) x 10 days
Cefuroxime (Ceftin®) 20 mg/kg/day, PO divided BID (maximum 500 mg/day) x 10 days
Cefdinir (Omnicef®) 14 mg/kg/day, PO divided QD/BID (maximum 600 mg/day) x 10 days
Cefpodoxime (Vantin®) 10 mg/kg/day, PO divided BID (maximum 400 mg/day) x 10 days
Ceftibuten (Cedax®) 9 mg/kg/day, PO given QD (maximum 400 mg/day) x 10 days

Adults (choose 1 of the following):

Cephalexin (Keflex®) 500 mg PO BID x 10 days
Cefadroxil (Duricef®) 500 mg PO BID or 1 gram PO QD x 10 days
Cefprozil (Cefzil®) 250-500 mg PO BID or 500 mg PO QD x 10 days
Cefuroxime (Ceftin®) 250 mg PO BID x 10 days
Cefdinir (Omnicef®) 300 mg PO BID or 600 mg PO QD 10 days
Cefpodoxime (Vantin®) 100 mg PO BID x 10 days
Ceftibuten (Cedax®) 400 mg PO QD x 10 days

Notes

Children with streptococcal pharyngitis should not return to school or child care during the first 24 hours after beginning antibiotics
If patient is allergic to cephalosporins in addition to their PCN allergy, clindamycin is generally selected
Follow-up throat culture is not routinely recommended

Adults and children who have severe penicillin allergy (hives or anaphylaxis) and live in an area where there is known macrolide resistant GABHS should receive clindamycin.

Children:

Clindamycin 8-20 mg/kg/day, PO divided TID/QID (maximum 1200 mg/day) x 10 days

Adults (choose 1 of the following):

Clindamycin 150-300 mg PO QID x 10 days

Notes

Children with streptococcal pharyngitis should not return to school or child care during the first 24 hours after beginning antibiotics
Follow-up throat culture is not routinely recommended

END

Is there known Erythromycin/Macrolide resistance of GABHS in your community?

Is there known Erythromycin/Macrolide resistance of GABHS in your community?

Less than 2 criteria present

2-4 criteria present

Obtain Rapid Streptococcal Antigen Test

Positive

Negative

Negative

Age less than 18 years?

Age greater than or equal to 18 years?

Penicillin Allergic?

Not Allergic

Mild Allergy

Severe Allergy (Hives/Anaphylaxis)

Not Allergic

Age less than 12 years?

Age between 12 and 17 years?

Age greater than or equal to 18 years?

Yes

No

Yes

No