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JohannaNokso-Koivisto

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.

Diagnosis Rapid Tests to Guide Antibiotic Prescriptions for Sore Throat

Treatment Antibiotic Treatments for Group A Streptococcal Pharyngitis in Children, Short Versus Standard Duration Antibiotic Therapy for Acute Streptococcal Pharyngitis in Children