Neobook — clinical reference

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ICD-10 Code: J03.0/J03.8-9/J35.0/J02.0/J02.8-9/J31.1-2

DESCRIPTION

A painful red throat and/or enlarged inflamed tonsils. White pus exudates, either spots or patches, may be present. Tender anterior cervical lymphadenopathy may be present
Viruses cause the majority of cases. Group A beta haemolytic streptococcus causes 20% of pharyngitis/ tonsillitis, and may result in rheumatic fever (which can cause serious heart disease) as well as local supportive complications
Other clinical features that might suggest streptococcal infection may include palatal petechiae, inflamed tongue mucosal papillae (strawberry tongue), a scarlitiniform (i.e.: rough, diffuse, fine papular) rash

GENERAL MEASURES

Homemade salt mouthwash, gargle for 1 minute twice daily:
- 2.5 mL (½ medicine measure) of table salt in 200 mL lukewarm water
- Do not give to children unable to gargle
Advise adequate hydration
Avoid irritants e.g. vaporubs inserted into nostrils
For children <6 years of age: Sooth the throat with breastmilk. If not exclusively breastfed, give warm water or weak tea: add sugar or honey and lemon if available

MEDICINE TREATMENT

Antibiotics are not required for all patients with a sore throat
Antibiotics to eradicate streptococci must be given to patients presenting with a sore throat who are at risk for rheumatic fever (3–21 years of age) if they have:
Enlarged tonsils;
- PLUS at least one of the following criteria:
- Exudates on their tonsils
- No cough
- No runny nose

LoE:I³⁹⁵

Benzathine benzylpenicillin, IM, single dose
- Children <30 kg: 600 000 IU
- Children ≥30 kg and adults: 1.2 MU
- Dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine) or 3 mL water for injection

Children

Amoxicillin, oral, 50 mg/kg daily for 10 days

Weight kg	Dose mg	Use one of the following:				Age Months/ years
		Susp		Capsule
		125 mg/5 mL	250 mg/5 mL	250 mg	500 mg
>2–2.5 kg	100 mg	4 mL	2 mL	–	–	>34–36 weeks
>2.5–3.5 kg	150 mg	6 mL	3 mL	–	–	>36 weeks-1 month
>3.5–5 kg	200 mg	8 mL	4 mL	–	–	>1–3 months
>5–7 kg	275 mg	11 mL	5.5 mL	–	–	>3–6 months
>7–11 kg	400 mg	–	8 mL	–	–	>6–18 months
>11–17.5 kg	575 mg	–	11.5 mL	–	–	>18 months–5 years
>17.5-25 kg	750 mg	–	15 mL	3	–	>5-7 years
>25-35 kg	1000 mg	–	20 mL	4	2	>7-11 years
>35 kg	2000 mg	–	–	–	4	>11 years

LoE:I³⁹⁶

Adults

Amoxicillin, oral, 1000 mg, 12 hourly for 10 days

LoE:III³⁹⁷

Children: 18 months–11 years of age

Phenoxymethylpenicillin, oral, 250 mg 12 hourly for 10 days

Children >11 years of age and adults

Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days

Severe Penicillin allergy:
ICD-10 Code: Z88.0

Children >3 years of age

Macrolide, e.g.:
Azithromycin, oral, 10 mg/kg daily for 3 days. See: dosing table

Children >35 kg and adults

Macrolide, e.g.:
Azithromycin, oral, 500 mg daily for 3 days

Pain:

Children

Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See: dosing table

Adults

Paracetamol, oral, 1 g 4–6 hourly when required
- Maximum dose: 15 mg/kg/dose
- Maximum dose: 4 g in 24 hours

REFERRAL

Any suppurative complications, e.g. retropharyngeal or peritonsillar abscess
Tonsillitis accompanied by difficulty in opening the mouth (trismus)
Recurrent tonsillitis (≥6 documented episodes/year) for possible tonsillectomy
Suspected acute rheumatic fever
Suspected acute glomerulonephritis
Heart murmurs not previously diagnosed

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition

Tonsillitis And Pharyngitis

DESCRIPTION

GENERAL MEASURES

MEDICINE TREATMENT

REFERRAL

Drugs mentioned

ICD-10 codes