Information
Editors
Pharyngitis and Tonsillitis in Children
Essentials
- Pharyngitis in children under school age is most commonly caused by a virus.
- Infections verifiably caused by group A streptococci are treated with antimicrobials. Otherwise, symptomatic treatment is sufficient.
- Epidemics caused by streptococci should be identified and managed; see the article Sore throat and tonsillitis Sore Throat and Tonsillitis.
Aetiology
- Adenoviruses are the most common aetiological agents.
- Streptococcal infections rarely occur in children below 3 years of age.
- Infectious mononucleosis Mononucleosis presents with only mild symptoms in small children. Treatment with antimicrobials is of no benefit for the child. A course of amoxicillin during the disease may provoke a red-spotted rash (picture 1).
Symptoms and signs
- Group A streptococcal infections usually present with fever and sore throat and the tonsils are coated and swollen, but clinical diagnosis is unreliable.
- Viruses may also cause exudative tonsillitis.
- If the patient in addition to fever and sore throat also has cough and rhinitis, he/she most probably has a viral respiratory infection. A rash is also possible during a viral infection.
- A NSAID http://www.dynamed.com/condition/streptococcal-pharyngitis#ANALGESICS for throat pain and fever. Administering the analgesic half an hour before a meal makes eating easier.
- Treatment of infections caused by group A streptococci:
- Penicillin Vhttp://www.dynamed.com/management/antibiotics-for-streptococcal-pharyngitis#PENICILLIN, 66 mg/kg/day (in children over 6 years of age when using tablets 50 000-100 000 IU/kg/day), or, if taking penicillin is not suitable, amoxicillin, 50 mg/kg/day, divided into 3 doses for 10 days.
- In patients with penicillin allergy, cephalexin http://www.dynamed.com/management/antibiotics-for-streptococcal-pharyngitis#CEPHALOSPORINS, 50 mg/kg/day, divided into 2 doses for 10 days, is used. Shorter treatment (3-6 days) with a cephalosporin may be equally effective. A shorter course may be considered e.g. if the child has difficulties in taking a long course of antimicrobials.
- Macrolides are only used in patients with penicillin and cephalosporin allergy according to sensitivity testing.
- The dosage for a child must not exceed that of an adult.
- Because of infectiousness, home care is recommended for one day after the onset of antimicrobial treatment. The total length of absence from day care or school is determined by the general condition.