Patient handout

Acute pharyngitis & tonsillitis (Centor/McIsaac, GAS vs viral, airway-emergency triage)

PRODUCTION

1. Your condition

This handout is for acute pharyngitis & tonsillitis (centor/mcisaac, gas vs viral, airway-emergency triage). Your care team identified this based on: acute sore throat / odynophagia ± fever — the dominant presentation; most viral, ~5-15% gas (idsa 2012 shulman pmid 22965026; acp/cdc 2016 harris pmid 26785402).

Other reasons your team may use this plan: tonsillar exudate + tender anterior cervical nodes + fever + no cough — high-centor picture (centor med decis making 1981 pmid 6763125; mcisaac jama 2004 pmid 15069046); sore throat with trismus / drooling / muffled voice / stridor / neck swelling / unilateral bulge — deep-space/airway emergency entry, route out (gottlieb j emerg med 2018 pmid 29523424); recurrent throat infections — recurrent-tonsillitis / paradise-criteria tonsillectomy-candidacy entry (idsa 2012 shulman pmid 22965026).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
no_antibiotic_if_low_score_or_negative_test_symptomatic_care_only	—	—	—	IDSA 2012 Shulman (PMID 22965026) + ACP/CDC 2016 Harris (PMID 26785402): treat ONLY confirmed GAS; do not test/treat asymptomatic carriers. Spinks Cochrane 2021 (PMID 34881426): 82% symptom-free by 1 wk untreated; NNT to prevent one sore throat at day-3 < 6, at 1 wk ≈ 18.

Plan: Confirmed-GAS targeted therapy, penicillin-allergy ladder, symptomatic care, and emergency routing

3. When to call your provider

Contact your care team if any of the following happen:

Airway/deep-space red flag → ED, route to ent.epiglottitis.core.v1 / ent.peritonsillar-abscess.core.v1 / ent.deep-neck-space-infection.core.v1 (Gottlieb PMID 29523424)
Toxic / hypotensive / qSOFA ≥2 → route to id.sepsis.core.v1
Persistent/worsening sore throat in a 15-30 y patient with rigors + unilateral neck tenderness → Lemierre — route to ent.deep-neck-space-infection.core.v1 (Gottlieb PMID 29523424)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Rapid-onset toxic patient, severe odynophagia out of proportion to oropharyngeal findings, drooling, muffled "hot-potato" voice, stridor, tripod/sniffing posture (Gottlieb J Emerg Med 2018 PMID 29523424)(life-threatening)
Trismus, unilateral tonsillar/pharyngeal bulge with contralateral uvular deviation, "hot-potato" voice (peritonsillar); neck stiffness/extension refusal, drooling, retropharyngeal bulge (retropharyngeal) (Gottlieb PMID 29523424)
Bilateral submandibular brawny induration, elevated/protruding tongue, floor-of-mouth swelling, trismus, drooling — rapidly progressive cellulitis of the submandibular space (Gottlieb PMID 29523424)(life-threatening)
Recent/persistent pharyngitis in an adolescent/young adult, rigors, unilateral anterior neck tenderness/swelling along the sternocleidomastoid, septic pulmonary emboli — Fusobacterium necrophorum internal-jugular septic thrombophlebitis (Gottlieb PMID 29523424)(life-threatening)
Inability to swallow secretions/pooling saliva, dehydration from odynophagia, or toxic appearance / qSOFA ≥2 / hypotension with a throat source

5. Follow-up

GAS: complete the full 10-day course (rheumatic-fever-prevention rationale even after symptoms resolve — Spinks Cochrane 2021 PMID 34881426, ARF Peto OR 0.36). Test-of-cure NOT routine (IDSA 2012). RECURRENT TONSILLITIS: apply Paradise criteria (≥7 episodes/1 y, ≥5/y × 2 y, or ≥3/y × 3 y, each well-documented) → ENT referral for tonsillectomy candidacy. Post-streptococcal sequelae counselling (ARF, PSGN). Penicillin-allergy de-labelling referral for reported (non-verified) allergy. Recurrent GAS / household-source / carrier-state considerations per IDSA 2012.

6. Sources

Guideline: IDSA 2012 Clinical Practice Guideline — Diagnosis & Management of Group A Streptococcal Pharyngitis (Shulman et al, CID, PMID 22965026) + ACP/CDC 2016 Appropriate Antibiotic Use for ARTI in Adults (Harris, Ann Intern Med, PMID 26785402) + NICE NG84 Sore throat (acute) 2018 (FeverPAIN/Centor) + Centor 1981 / McIsaac 2004 score validation (PMID 6763125, 15069046) + Cochrane antibiotics for sore throat (Spinks 2021 PMID 34881426; Del Mar 2006 PMID 17054126) + Cochrane corticosteroids for sore throat (de Cassan 2020 PMID 32356360)