Tonsillopharyngitis

• Diphtheria infections require urgent specialist (Otolaryngology, Infectious Diseases) referral.

Pathogens

• Common: Viruses, S. pyogenes
• Other: Corynebacterium diphtheriae, Chlamydia pneumoniae, N. gonorrhoeae, Mycoplasma pneumoniae

Drug Treatment

• Most are viral and do not need antimicrobials.
• Features of S. pyogenes include: temp > 38°C, tender lymphadenopathy, tonsillar exudate, no cough.
• Duration: At least 10 days.

Streptococcal pharyngitis

phenoxymethylpenicillin HMLSchedNZFPML Phenoxymethylpenicillin F: 0.4 Half life: 0.5 hours Elimination: renal fe: 0.9 (Penicillin V)

PO 500 mg twice a day

• fe = 0.9, consider adjusting dose if CrCl is reduced.

Mild penicillin allergy or other organisms isolated

cefalexin HMLSchedNZFPML Cefalexin F: 0.9 Half life: 1 hour Elimination: renal fe: 0.9

PO 1000 mg twice a day

• fe = 0.9, consider adjusting dose if CrCl is reduced.

Severe penicillin allergy or other organisms isolated

roxithromycin HMLSchedNZFPML Roxithromycin F: 0.8 Half life: 12 hours Elimination: CYP3A fe: 0.1

PO 300 mg once a day

• If pregnant, consider erythromycin instead of roxithromycin as there are less safety in pregnancy data available for roxithromycin.
• Metabolised by and inhibits CYP3A. (fe < 0.1).
• Subject to P-glycoprotein inhibition and induction.

Topic Code: 99225

must be prescribed or recommended by a consultant.