&nbsp; Summary: Dr. Robert Centor’s Knowledge Food, Part 2! &nbsp;On this episode of The Curbsiders, we continue our discussion with the legendary Dr. Centor, focusing on pharyngitis and the highly entertaining origin of the Centor Criteria. &nbsp;Not only do we learn how to dominate pharyngitis, but we also uncover one of Dr. Watto’s knowledge deficits - Lemierre’s Syndrome. &nbsp;(He owes us a two minute talk on Lemierre’s Syndrome in case you’re wondering. I know I am.) Clinical Pearls:  Admit your own limitations! &nbsp;Many overestimate their skills as a clinical educator.  Preadolescents get streptococcal pharyngitis (...or it’s nothing). Adolescents are much more complicated with streptococcus, EBV, CMV, acute HIV, fusobacterium, and multiple other causes.   Important: Separate the causes of pharyngitis in preadolescents and adolescents.  General rule: Sore throats should not cause rigors; if present then admit patient, obtain blood cultures, and start antibiotics.   Do NOT miss a peritonsillar abscess or Lemierre’s Syndrome in acute pharyngitis. Pharyngitis improves within three to five days. &nbsp;Failure to improve should prompt a more thorough investigation. Lemierre’s Syndrome (1 in 70,000 untreated pharyngitis patients) is septic thrombophlebitis of the internal jugular vein. &nbsp;The treatment is IV antibiotics and NOT anticoagulation. &nbsp; Dr. Centor and the IDSA recommends Amoxicillin once daily and, if penicillin allergic, Clindamycin. &nbsp;The most recent IDSA update recommends a 10-day course of Amoxicillin (50mg/kg up to 1000mg once daily).  Dr. Centor’s “Take-Home” Points:  Adolescents tend to have more complicated pharyngitis Pharyngitis and rigors? &nbsp;Admit, obtain cultures, and start antibiotics. Sore throats don’t get worse and, if they do, you need to rethink the case  Disclosures: Dr. Centor reports no relevant financial disclosures for this topic. Learning objectives: By the end of this podcast listeners will be able to:  Identify the limitations of the Centor Criteria in regards to (a) preadolescents and (b) adolescents, taking special precautions in the adolescent population Understand which acute pharyngitis patients require a more thorough investigation Be able to identify Amoxicillin as the treatment of choice for acute bacterial pharyngitis with Clindamycin as the second-line antibiotics choice.  Links from the show:  Check our Dr. Centor’s wonderful blog, at http://www.medrants.com or on twitter https://twitter.com/medrants Centor’s Criteria (MDCalc) --  http://www.mdcalc.com/modified-centor-score-for-strep-pharyngitis/ IDSA Guidelines on Diagnosis and Management of Group A Streptococcus Pharyngitis -  http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full.pdf+html Original article using the Centor score for pharyngitis  https://www.ncbi.nlm.nih.gov/pubmed/6763125?dopt=abstract Dr. Centor’s article on fusobacterium Centor RM, et al. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med. 2015 Feb 17;162(4):241-7. doi: 10.7326/M14-1305.

Sore throat? Absent cough? Ask Doctor Centor.

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