Diagnostic Approach
| Points | Probability of Strep | Management |
|---|---|---|
| 1 or less | <10% | No antibiotic or culture needed |
| 2 | 11–17% | Antibiotic based on culture or RADT |
| 3 | 28–35% | |
| 4 or 5 | 52% | Empiric antibiotics |
It is hard to differentiate a viral and a bacterial cause of a sore throat based on symptoms alone. Thus often a throat swab is done to rule out a bacterial cause.
The modified Centor criteria may be used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.
One point is given for each of the criteria:
- Absence of a cough
- Swollen and tender cervical lymph nodes
- Temperature >38.0 °C (100.4 °F)
- Tonsillar exudate or swelling
- Age less than 15 (a point is subtracted if age >44)
The McIsaac criteria adds to the Centor:
- Age less than 15: add one point
- Age greater than 45: subtract one point
The Infectious Disease Society of America however recommends against empirical treatment and considers antibiotics only appropriate following positive testing. Testing is not needed in children under three as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.
Read more about this topic: Pharyngitis
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