Otolaryngology Book

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Chronic Pharyngeal Carriage of Streptococcus pyogenes

Aka: Chronic Pharyngeal Carriage of Streptococcus pyogenes, Group A Streptococcus Pharyngeal Carrier, GAS Pharyngeal Carrier
  1. See Also
    1. Group A Streptococcal Pharyngitis
    2. Pharyngitis
    3. Pharyngitis Causes
    4. Dysphagia
    5. Tonsillitis
    6. Peritonsillar Abscess
    7. Retropharyngeal Abscess
    8. Lemierre Syndrome
    9. Diphtheria
    10. Tonsillectomy Indications
  2. Signs
    1. Recurrent episodes Streptococcal Pharyngitis
    2. GAS Pharyngitis diagnosed with every new cold
    3. Pharyngitis presumed due to non-GAS cause
  3. Diagnosis (Test when patient is well and asymptomatic)
    1. Throat Culture
    2. Streptococcal Antibody titer (ASO)
      1. Obtain baseline value
      2. Repeat in 4-6 weeks
  4. Indications for antibiotic treatment for GAS carriers
    1. Acute Rheumatic Fever outbreak
    2. Poststreptococcal Glomerulonephritis outbreak
    3. GAS Pharyngitis outbreak in closed community
    4. Rheumatic FeverFamily History
    5. Multiple symptomatic GAS Pharyngitis episodes in family
    6. Excessive family worry regarding GAS Pharyngitis
    7. Tonsillectomy considered for GAS Carriage
    8. Household contact with episode of severe GAS infection
      1. GAS Toxic Shock Syndrome
      2. GAS Necrotizing Fasciitis
  5. Management: Eradication of Streptococcal Carriage
    1. Indications as listed above
    2. First-Line: Clindamycin
      1. Child: 20 mg/kg/day PO divided tid for 10 days
      2. Adult: 600 mg PO tid for 10 days
    3. Alternative agents
      1. Amoxicillin-Clavulanate (Augmentin)
      2. Combination
        1. Rifampin 10 mg/kg PO bid for 4 days and
        2. Benzathine Penicillin
  6. References
    1. (2000) AAP Red Book, p. 532
    2. Mandell (2000) Principles Infectious Disease, p. 353

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