Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Children with Suspected Pharyngitis or Peritonsillar Abscess (PTA)
- Concern for Complications of PTA
- ENT Consult
- As clinically indicated:
- RN standing order for rapid strep:
- Chief complaint: sore throat
- Age ≥ 3 yrs
- No new viral URI symptoms
- Features of PTA
- Palatal fullness
- Uvula deviation
- Trismus
- Unilateral throat pain, ipsilateral otalgia
Pharyngitis
Peritonsillar Cellulitis/Possible PTA
Clinical PTA
- Rapid strep if features of strep pharyngitis
- Rapid strep testing not recommended for:
- Prominent viral symptoms
- Age 3 yrs w/o known exposure
- Consider STI in sexually active adolescent
- Viral Pharyngitis
- Monospot or EBV serologies as indicated
- Supportive care
- Strep Pharyngitis
- Assess ability to tolerate
bedside drainage- Consider Child Life Consult
Unable to tolerate bedside drainage
Able to tolerate bedside drainage
Consider Imaging
- Consider Imaging
- Consider ENT Consult based on imaging
Consult ENT for Bedside Drainage
Disposition
Disposition
Discharge
- Tolerating PO
- Pain controlled
Admit
For dehydration
Discharge
- Tolerating PO
- Pain controlled
- Antibiotic Recommendations
- Consider dexamethasone
0.6 mg/kg/dose once, max 8 mg
Admit
- Antibiotic Recommendations
- Consider dexamethasone
0.6 mg/kg/dose once, max 8 mg
- Discharge for PTA
- Successful drainage
(if attempted) - Follow up with PCP in 48 hrs
- If second occurrence of PTA, follow up with ENT to discuss elective tonsillectomy
- Successful drainage
Posted: November 2023
Editors: Clinical Pathways Team
Editors: Clinical Pathways Team
Evidence
- Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America
- Tonsil Ultrasound: Technical Approach and Spectrum of Pediatric Peritonsillar Infections
- Utilization of Ultrasound for Diagnostic Evaluation and Management of Peritonsillar Abscesses
- Pediatric Peritonsillar Abscess: Outcomes and Cost Savings from Using Transcervical Ultrasound
- A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses
- Impact of Viral Symptoms on the Performance of the Modified Centor Score to Predict Pediatric Group A Streptococcal Pharyngitis
- Improving the Prediction of Streptococcal Pharyngitis; Time to Move Past Exudate Alone
- Managing Peritonsillar Abscess
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