A woman, aged 20 years, with no known drug allergies, no current medications and no medical history presented with a sore throat, “clogged” ears, and possible fever for the past three to four days. At the time of her visit, however, she reported feeling better overall and just wanted to make sure she did not have the flu.

Clinical examination revealed a smiling, pleasant, conversational, afebrile patient with normal tympanic membranes; nonpainful sinuses, and tonsils that were inflamed, red and covered with exudates. Minimal cervical lymphadenopathy was noted. Instead of treating immediately, a throat culture was obtained.

The throat culture indicated streptococci. The student returned for her results two days later, and her throat looked normal with no exudates or inflammation. She was treated with a 10-day course of penicillin VK because of the possibility of recurrence and the complications resulting from streptococcus (e.g., endocarditis, glomerulonephritis). Was this the right decision? — Kathy P. McGovern, CRNP, Glenside, Pa.

This was absolutely the right decision. Symptoms of streptococcal pharyngitis will resolve even without antibiotic treatment in a normal healthy young woman. The goal of antibiotic therapy is to prevent the occurrence of sequelae.

The CDC has a fact sheet that provides useful information on the background, diagnosis and treatment of acute pharyngitis in adults. — Julee B. Waldrop, DNP (180-4)


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a question, submit it here.