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- Risa E. Bochner, MD*
- Mona Gangar, MD*,†
- Peter F. Belamarich, MD*
- *Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY
- †Department of Otorhinolaryngology/Head and Neck Surgery, Division of Pediatric Otorhinolaryngology, Albert Einstein College of Medicine, Bronx, NY
AUTHOR DISCLOSURE
Drs Bochner and Gangar have disclosed no financial relationships relevant to this article. Dr Belamarich has disclosed that he served as site principal investigator for his practice's recently completed participation in a national multicenter performance improvement project with the National Immunization Partnership and the APA (NIPA) entitled Improving HPV Immunization Rates in Practice-Based Settings and funded by CDC-APA Partnership Grant #1H23IP000950. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- ALPS:
- Autoimmune lymphoproliferative syndrome
- ARF:
- Acute rheumatic fever
- CMV:
- Cytomegalovirus
- CT:
- Computed tomography
- EBV:
- Epstein-Barr virus
- GAS:
- Group A Streptococcus
- HIV:
- Human immunodeficiency virus
- NSAIDs:
- Nonsteroidal anti-inflammatory drugs
- OSA:
- Obstructive sleep apnea
- PFAPA:
- Periodic fever, apthous stomatitis, pharyngitis, and adenitis
- PSGN:
- Poststreptococcal glomerulonephritis
- PTA:
- Peritonsillar abscess
- RADT:
- Rapid antigen detection test
- SDB:
- Sleep-disordered breathing
- T&A:
- Tonsillectomy and adenoidectomy
Practice Gap
Despite established guidelines for group A Streptococcus pharyngitis diagnosis and treatment, pediatricians are overtreating and mistreating sore throat in children. (1) This results in unnecessary antibiotic use and contributes to antimicrobial resistance, increased health care costs, and risk for adverse drug reactions. In addition, controversy exists among pediatricians regarding the indications for tonsillectomy and adenoidectomy in children.
Objectives
After completing this article, readers should be able to:
Describe the clinical presentation, differential diagnosis, diagnostic evaluation, and management of tonsillitis/pharyngitis in pediatric patients.
Describe the clinical presentation, diagnostic evaluation, and management of peritonsillar abscess in pediatric patients.
Describe the clinical presentation, diagnostic evaluation, and management of retropharyngeal abscess in pediatric patients.
Describe the indications for tonsillectomy and adenoidectomy in pediatric patients and associated complications.
Tonsillitis, Pharyngitis
Epidemiology
Sore throat is a common complaint in children and adolescents. Most cases of pharyngitis are viral and self-limited. Group A Streptococcus (GAS) pharyngitis is the only commonly occurring infectious pharyngitis in which antimicrobial treatment is indicated. Treatment of GAS decreases the risk of acute rheumatic fever (ARF), suppurative complications and transmission of disease, and provides symptomatic relief. GAS pharyngitis accounts for 20%-30% of office visits for sore throats in children. (2) Infection typically occurs in school-age children and adolescents, and is uncommon in children younger than 3 years. GAS pharyngitis occurs most commonly in the winter and early spring months …
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