›Critical patient workflow
›Monitoring
›Continuous pulse oximetry if respiratory symptoms
›Cardiac monitor if toxicity or sepsis concern
›Oxygenation
›Supplemental oxygen for hypoxia
›Escalation to high flow oxygen for respiratory distress
›Access and labs
›IV access if dehydration or toxicity
›Point of care glucose if altered mental status
›Airway escalation
›Immediate airway team activation for stridor with distress
›Avoid agitating maneuvers if epiglottitis concern
›Testing pathway
›Low risk for GAS
›No testing
›Supportive care only
›Intermediate risk for GAS
›Rapid test or NAAT
›Culture confirmation strategy for children and adolescents when rapid negative
›High risk for complications
›Early imaging for deep neck infection concern
›Early ENT or anesthesia involvement for airway concern
›Analgesia and antipyresis
›Acetaminophen
›Adult example 1000 mg PO every 6 to 8 hours
›Maximum 3000 mg per day local protocol dependent
›Ibuprofen
›Adult example 400 mg PO every 6 to 8 hours
›Avoid in CKD or GI bleed risk
›Dexamethasone for severe odynophagia
›Adult example 10 mg PO or IV once
›Avoid if concern for uncontrolled infection without antibiotics
›Antibiotics for confirmed or strongly suspected GAS
›Penicillin V
›Adult example 500 mg PO twice daily for 10 days
›Amoxicillin
›Adult example 500 mg PO twice daily for 10 days
›Avoid in suspected EBV due to rash risk
›Benzathine penicillin G IM
›Adult example 1.2 million units IM once
›Non anaphylactic penicillin allergy
›Cephalexin adult example 500 mg PO twice daily for 10 days
›Avoid if immediate type hypersensitivity history
›Immediate type penicillin allergy
›Azithromycin adult example 500 mg PO day 1
›Azithromycin adult example 250 mg PO days 2 to 5
›Clindamycin adult example 300 mg PO three times daily for 10 days
›Peritonsillar abscess management
›Drainage pathway
›Needle aspiration or incision and drainage
›Airway backup planning
›Antibiotics
›Ampicillin sulbactam IV local protocol dependent
›Clindamycin IV local protocol dependent
›Epiglottitis management
›Airway first strategy
›Controlled airway with expert team
›Avoid oral exam that worsens distress
›Antibiotics
›Ceftriaxone IV local protocol dependent
›Add vancomycin IV local protocol dependent if MRSA risk
›Pregnancy and postpartum
›Penicillins generally preferred when indicated
›Avoid tetracyclines
›Immunocompromised
›Lower threshold for imaging
›Lower threshold for admission
›Pediatrics and adolescents
›Weight based dosing for analgesics and antibiotics
›Culture confirmation strategy after negative rapid test when indicated per local guideline