›Immediate priorities
›Continuous pulse oximetry if airway concern
›Cardiac monitoring if unstable vitals
›IV access criteria
›Toxic appearance
›Unable to tolerate oral intake
›Oxygen
›If SpO2 less than 92 percent
›If increased work of breathing
›Early consult activation
›ENT for suspected deep neck infection
›Anesthesia for anticipated difficult airway
Analgesia and symptom control
›Pain and fever control
›Acetaminophen PO 1000 mg once
›Maximum 4000 mg per 24 hours
›Ibuprofen PO 400 mg once
›Maximum 2400 mg per 24 hours
›Topical therapies
›Viscous lidocaine 2 percent 10 mL swish and spit once
›Aspiration risk caution in impaired swallow
Antibiotics decision pathway
›Suspected GAS management local protocol dependent
›If RADT positive, antibiotics
›If RADT negative in child, throat culture pathway
›Adult antibiotic examples
›Penicillin V PO 500 mg twice daily for 10 days
›Amoxicillin PO 500 mg twice daily for 10 days
›Penicillin allergy alternatives
›Cephalexin PO 500 mg twice daily for 10 days if non anaphylactic allergy
›Azithromycin PO 500 mg once then 250 mg daily for 4 days
Deep neck infection management
›Suspected peritonsillar abscess
›Drainage local protocol dependent
›Amoxicillin clavulanate PO 875 mg twice daily
›Clindamycin PO 300 mg four times daily
›Suspected retropharyngeal abscess or Ludwig angina
›Ampicillin sulbactam IV 3 g every 6 hours
›Clindamycin IV 900 mg every 8 hours if beta lactam allergy
›Add MRSA coverage if risk local protocol dependent
›Reassessment timing
›Recheck vitals within 30 to 60 minutes if moderate symptoms
›Recheck airway status within 15 minutes if any airway concern
›Pain response after analgesia within 30 minutes