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Pharyngitis, Emergency Medicine

John C. Greenwood and Brian J. Browne Reviewed 06/2017



  • Inflammation/infection of the pharynx

  • 3rd most common complaint for physician visits

  • 30 million cases diagnosed annually

  • Group A β-hemolytic streptococcus (GAS):

    • Streptococcus pyogenes

    • Un...


Signs and Symptoms


  • Viral:

    • Cough

    • Rhinorrhea

    • Sore throat usually follows

    • Have a high suspicion for acute HIV in at-risk patients presenting with persistent pharyngitis despite treatment

  • Bacte...



  • Observe/manage airway for respiratory distress

  • Normal saline (NS) hydration for hypotension/dehydration

Initial Stabilization/Therapy

  • ABCs

  • Fluid resuscitation: 1 L (peds: 20 mL/kg) N...



Admission Criteria

  • Airway compromise

  • Severe dehydration

  • Suspected child abuse

Discharge Criteria

Able to tolerate oral intake 

Follow-Up Recommendations

  • If symptoms do not improve within...

Pearls and Pitfalls

  • Use the modified Centor criteria to make the decision to test for GAS pharyngitis

  • Children with negative RADT need follow-up throat culture

  • Acute rheumatic fever is a more common com...

Additional Reading

  • Hayward  G, Thompson  M, Heneghan  C, et al. Corticosteroids for pain relief in sore throat: Systemic review and meta-analysis. BMJ.  2009;339:b2976.

  • Kociolek  LK, Shulman  ST. ...



  • 034.0 Streptococcal sore throat

  • 054.79 Herpes simplex with other specified complications

  • 462 Acute pharyngitis

  • 487.1 Influenza with other respiratory manifestations


  • J02.0 Streptococcal phar...

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