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Acute Tonsillopharyngitis Protocol (PAFP)

Respiratory

1. Assessment & Diagnosis

  • Etiology: Most cases are viral (e.g., Adenovirus, Rhinovirus). Only 5-15% of adults have Group A Beta-Hemolytic Streptococcus (GABHS) or "Strep Throat".
  • Differentiation:
  • Viral Signs: Cough, coryza (runny nose), hoarseness, and conjunctivitis usually indicate a viral cause.
  • Bacterial Signs (Strep): Sudden onset sore throat, fever, tonsillar exudates (white patches), and tender cervical lymph nodes. Absence of cough is a key predictor.
  • Scoring: Use the Modified Centor Score to determine if antibiotics or testing is needed.
  • Score 0-1: Viral likely. No antibiotic/testing needed.
  • Score 2-3: Request Rapid Antigen Test or Culture.
  • Score 4: Empiric treatment may be considered.

    • 2. Management

  • Viral Pharyngitis: Supportive care only.
  • Pain Relief: Paracetamol or Ibuprofen.
  • Hydration: Saltwater gargles and increased fluid intake.
  • Streptococcal Pharyngitis (Confirmed):
  • Goal: Prevent Rheumatic Fever and suppurative complications.
  • Antibiotic of Choice: Penicillin V or Amoxicillin (standard course). Erythromycin/Clindamycin for penicillin-allergic patients.
  • Rational Use: Do NOT prescribe antibiotics for viral sore throats to prevent resistance.
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    Warning Signs

    COMPLICATIONS (Refer Immediately)

  • Peritonsillar Abscess: Severe unilateral pain, trismus (lockjaw), "hot potato" voice, and uvula deviation.
  • Airway Obstruction: Stridor, drooling, or difficulty breathing.
  • Signs of Rheumatic Fever: Joint pain, new heart murmur, or rash.
  • Severe Dehydration: Inability to swallow liquids.

    • Reference

    1. Daisy M. Medina, MD, et al. (Philippine Academy of Family Physicians) (2020). Diagnosis and Management of Acute Tonsillopharyngitis in Family Practice (PAFP Clinical Pathways).
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