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Pharyngitis

Matthew DeLaney, MD and Rick Pescatore, DO
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18:17
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Rick and Matt tackle the surprisingly complex topic of pharyngitis and take a deep dive on the microbiology and considerations of antibiotic treatment.

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Charles M. -

Where is the link to Rick's article promised in the audio?

Mike W., MD -

Here it is, thx for picking this up!:
https://journals.lww.com/em-news/Fulltext/2018/09000/What_to_D_O___Reject_Strep_versus_Virus_Paradigm.13.aspx

Jordan A. -

What is the utility of a throat culture? Can that help in ruling out a bacterial infection if there is a good collection? Or is the sensitivity not that high?

Mike W., MD -

From Rick P:
I think there’s benefit, for identification of things like gonococcal pharyngitis, or non-streptococcal species such as GCS, F necrophorum

Eliana A., PAC -

What is the incidence of PSGN? Post strep glomerulonephritis? I didn't hear it mentioned during the discussion. I've always told my pts that untreated strep can potentially cause other problems among them abscesses, heart valve (although rare), and kidney inflammation, which is why we treat. " Any recent throat infections?" is also a question I ask my patients with dark proteinaceous urine. Any thoughts?

Mike W., MD -

From Pescatore:
Vanishingly small, with a NNT far higher than suppurative complications and of questionable relationship to pharyngeal infections in developed countries. Avoidance of PSGN should, IMO, not play a significant role in the risk/benefit analysis of antibiotics for pharyngitis.

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ID Killers Full episode audio for MD edition 206:50 min - 97 MB - M4AHippo Urgent Care RAP - June 2019 Written Summary 405 KB - PDF

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