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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sore throat usually is caused by viral pharyngitis, in about 15 to 30% by group A beta-haemolytic streptococci. Based on current concepts a guideline for the management in general practice is developed. If the typical symptoms of streptococcal pharyngo-tonsillitis are present--serious sore throat, fever more than 38.5 degrees C, purulent tonsillar exsudate, painful cervical lymphadenopathy, lack of cough or rhinorrhea--without any other diagnostic procedure penicillin is given for ten days. Only in cases of doubt throat swabs are taken for rapid diagnostic test and culture. The implementation of the guideline permits differentiation between viral pharyngitis and streptococcal tonsillitis by simple questions and physical examination and prevention of unnecessary diagnostics and antibiotic overuse.
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PMID:[Sore throat in general practice. Minimizing diagnosis--preventing superfluous use of antibiotics]. 1091 40

Although most instances of sore throat are caused by relatively benign infectious or noninfectious processes, pharyngitis may herald serious or even fatal illnesses. Viral pharyngitis is the diagnosis in most cases, but because GABHS is the most common bacterial organism requiring antimicrobial treatment, an office visit is often necessary. There is no exact constellation of signs and symptoms that is pathognomonic for GABHS; nevertheless, sudden onset of sore throat with fever and cervical lymph node tenderness, in the absence of cough and nasal symptoms, is at least suggestive in adults, and possibly in children. Physical examination and prudent use of laboratory testing will assist in the diagnosis of both acute and chronic pharyngitis. The primary care provider who promptly identifies and properly treats patients infected with S. pyogenes has reduced the number of missed school or work days, the risk of developing ARF, the likelihood of transmission to others, and inappropriate use of antibiotics for those with other causes of sore throat. Further education of patient, family, and other clinicians will reduce medical expenses, avoid unnecessary antibiotic exposure, and inform the public regarding judicious management of pharyngitis.
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PMID:Acute and chronic pharyngitis across the lifespan. 1193 37

Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4 degrees F (38 degrees C), tonsillar exudates, and cervical adenopathy. Cough, coryza, and diarrhea are more common with viral pharyngitis. Available diagnostic tests include throat culture and rapid antigen detection testing. Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly. The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy. Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice because of cost, narrow spectrum of activity, and effectiveness. Amoxicillin is equally effective and more palatable. Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy. Increased group A beta-hemolytic streptococcus (GABHS) treatment failure with penicillin has been reported. Although current guidelines recommend first-generation cephalosporins for persons with penicillin allergy, some advocate the use of cephalosporins in all nonallergic patients because of better GABHS eradication and effectiveness against chronic GABHS carriage. Chronic GABHS colonization is common despite appropriate use of antibiotic therapy. Chronic carriers are at low risk of transmitting disease or developing invasive GABHS infections, and there is generally no need to treat carriers. Whether tonsillectomy or adenoidectomy decreases the incidence of GABHS pharyngitis is poorly understood. At this time, the benefits are too small to outweigh the associated costs and surgical risks.
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PMID:Diagnosis and treatment of streptococcal pharyngitis. 2052 48

Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).
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PMID:Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015. 2671 90

Influenza is a very common cause of upper respiratory illness, rarely presented with bicytopenia, and is being wrongly treated with antimicrobials many-a-times. We report a case of 36-year-old North-Indian man, physician by profession who presented with a 5-day history of typical upper respiratory tract symptoms (sore throat, irritative cough, hoarseness of voice, coryza) and high-grade fever for which he took antibiotics (initially levofloxacin for 2-days, followed by azithromycin) after self-prescription. He developed hematological involvement (leukopenia and thrombocytopenia) for which he was admitted. Throat swab tested positive for Influenza B by RT-PCR. This case highlights a rare presentation of influenza as bicytopenia which rapidly improved with oseltamivir given for 5-days. This is also a classic case of lack of antimicrobial stewardship practice by a physician while self-treating viral pharyngitis. There is a pressing need to create more awareness regarding appropriate use of antimicrobial resources among doctors, only then will others follow.
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PMID:Influenza B presenting with bicytopenia in an adult - An unusual presentation and failure of antimicrobial stewardship by a practicing physician. 3310 60