FARINGITIS

DEFINISI
Faringitis adalah suatu peradangan pada tenggorokan (faring). (medicastore.com) Faringitis (dalam bahasa Latin; pharyngitis), adalah suatu penyakit peradangan yang menyerang tenggorok atau faring. Kadang juga disebut sebagai radang tenggorok. (id.wikipedia.org) Pharyngitis is inflammation of the pharynx, hi!h is in the ba!k of the throat, bet een the tonsils and the "oi!ebox (larynx). #nflamasi pada faring yang mana terletak di belakang tenggorokan, antara tonsil dan kotak suara (laring) ( .nlm.nih.go")

Pharyngitis is defined as an infe!tion or irritation of the pharynx and$or tonsils. (emedi!ine.meds!ape.!om)

ETIOLOGI Faringitis bisa disebabkan oleh "irus maupun bakteri. Kebanyakan disebabkan oleh "irus, termasuk "irus penyebab common cold, flu, adeno"irus, mononukleosis atau HIV. %akteri yang menyebabkan faringitis adalah streptokokus grup &, korinebakterium, arkanobakterium, Neisseria gonorrhoeae atau Chlamydia pneumoniae. (medicastore.com) 'adang ini bisa disebabkan oleh "irus atau kuman, disebabkan daya tahan yang lemah. (id.wikipedia.org) Faringitis umum terjadi diseluruh dunia. (iiklim dingin, paling umum terjadi pada akhir musim gugur, selama musim dingin dan a al musim semi. )diindonesia umumnya terjadi pada saat pan!aroba dan selama musim hujan,* ujar dokter +oekirman. Faringitis akut adalah keluhan utama pasien pada kunjungan kedokter. (iperkirakan, tiap tahunya di &+ lebih dari ,- juta pasien mengunjungi dokter dengan keluhan sakit tenggorokan. Faringitis dapat disebabkan oleh berbagai mikrobia, baik sebagai manifestasi tunggal maupun sebagai bagian dari penyakit lain. +akit tenggorokan, malaise dan demam !ukup mengganggu pasien. &kan tetapi, dengan beberapa penge!ualian (misalnya infeksi oleh streptokokus %.hemolitik atau difteria), penyakit ini ringan dan dapat sembuh dengan sendirinya. /roup & beta.hemolitik streptokokus (/&%0+) dapat menyebabkan faringitis akut, terhitung ,-.123 kasus pada anak dan -.,23 kasus pada de asa di &+. *diindonesia, kasusnya tidak banyak, hanya sekitar ,.43. (i &+, faringitis akibat /&%0+ umumnya menyerang anak usia -.,- tahun.,*kata dr.+oekirman. Penggunaan agen mikrobia diindikasi untuk /&%0+. 5idak mengobati /&%0+ dapat menyebabkan berbagai komplikasi supuratif (abses peritonsilar, mastoiditis dan lain.lain) dan nonsupuratif ( demam reumatik; insiden demam reumatik akut sekitar 2,41.,,66$,22.222). pengobatan faringitis "iral dengan agen mikrobial, tidaklah berguna. Karenanya, strategi untuk diagnosa dan pengobatan infeksi faringitis akut utamanya ditujukan dalam mengidentifikasi penderita strep throat yang memerlukan terapi antimikrobia,

serta men!egah pengobatan yang tidak diperlukan bagi pasien dengan faringitis "iral akut. (farmasiinfo.blogspot.com) 7any germs !an !ause pharyngitis.

Viruses are the most common cause of pharyngitis. Many different viruses can cause pharyngitis.
o

8iral pharyngitis is the most !ommon !ause of a sore throat. Pharyngitis may o!!ur as part of a "iral infe!tion that also in"ol"es other organ systems, su!h as the lungs or bo el.

Bacteria that can cause pharyngitis include Group A streptococcus, which leads to strep throat in some cases. Other, less common !acteria that cause sore throats include coryne!acterium, arcano!acterium, Neisseria gonorrhoeae, and Chlamydia pneumoniae.

7ost !ases of pharyngitis o!!ur during the !older months. 5he illness often spreads among family members.

%a!terial pharyngitis o /roup & beta.hemolyti! strepto!o!!i9 5he !lassi! !lini!al pi!ture in!ludes a fe"er, temperature of greater than ,2,.-:F; tonsillopharyngeal erythema and exudate; s ollen, tender anterior !er"i!al adenopathy; heada!he; emesis in !hildren; palatal pete!hiae; mid inter to early spring season; and absent !ough or rhinorrhea.;
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/roup <, /, and F strepto!o!!i may be indistinguishable !lini!ally from /&+ infe!tion. &!ute glomerulonephritis is an extremely unusual !ompli!ation of group < strepto!o!!al pharyngitis, but a relationship bet een group / strepto!o!!al pharyngitis and a!ute glomerulonephritis has not be established. &!ute rheumati! fe"er has not been des!ribed as a !ompli!ation of either. 5hey may be asso!iated ith food.borne outbreaks. 5he benefit of antibioti! therapy ith these types of strepto!o!!i is unpro"en at this time.Arcanobacterium (Corynebacterium) haemolyticus is more !ommon in young adults and is "ery similar to /&+ infe!tion, in!luding a similar s!arlatiniform rash. Patients often ha"e a !ough. =!!asional outbreaks ha"e been reported. M pneumoniae in young adults presents ith heada!he, pharyngitis, and lo er respiratory symptoms. &pproximately >-3 of patients ha"e a !ough, hi!h is distin!ti"e from /&+ infe!tion. C pneumoniae has a !lini!al pi!ture similar to that of M pneumoniae. Pharyngitis usually pre!edes the pulmonary infe!tion by about ,.1 eeks. Neisseria gonorrhoeae is a rare !ause of pharyngitis. & !areful history is important sin!e infe!tion usually follo s orogenital !onta!t. #t may be asso!iated ith se"ere systemi! infe!tion. Corynebacterium diphtheriae is rare in the ?nited +tates. & foul.smelling gray. hite pharyngeal membrane may result in air ay obstru!tion.

8iral pharyngitis1
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&deno"irus9 5he distinguishing feature of an adeno"irus infe!tion is !onjun!ti"itis asso!iated ith pharyngitis (pharyngo!onjun!ti"al fe"er). #t is the most !ommon etiology in !hildren younger than 1 years. 0erpes simplex9 8esi!ular lesions (herpangina), espe!ially in young !hildren, are the hallmark. #n older patients, pharyngitis may be indistinguishable from /&%0+ infe!tion. <oxsa!kie"iruses & and %9 5hese infe!tions present similarly to herpes simplex, and "esi!les may be present. #f "esi!les are hitish and nodular, it is kno n as lymphonodular pharyngitis. <oxsa!kie"irus &,@ may !ause hand.foot.and.mouth disease, hi!h presents

ith A. to 6.mm oropharyngeal ul!ers and "esi!les on the hands and feet, and, o!!asionally, on the butto!ks. 5he oropharyngeal ul!ers and "esi!les resol"e ithin , eek.
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Bpstein.%arr "irus (B%8)9 <lini!ally kno n as infe!tious mononu!leosis, it is extremely diffi!ult to distinguish from /&+ infe!tion. Bxudati"e pharyngitis is prominent. (istin!ti"e features in!lude retro!er"i!al or generaliCed adenopathy and hepatosplenomegaly. &typi!al lympho!ytes !an be seen on peripheral blood smear. 8iral !ultures from ashings are about 423 sensiti"e in adults. <789 Presentation of <78 is similar to the presentation of infe!tious mononu!leosis. Patients tend to be older, are sexually a!ti"e, and ha"e higher fe"er and more malaise. Pharyngitis may not be a prominent !omplaint. 0#8.,9 5his is asso!iated ith pharyngeal edema and erythema, !ommon aphthous ul!ers, and a rarity of exudates. Fe"er, myalgia, and lymphadenopathy also are found.

=ther !auses of pharyngitis

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=ral thrush is due to !andidal spe!ies, usually in patients ho are immuno!ompromised. #t may be !ommon in young !hildren and presents ith hitish plaDues in the oropharynx. =ther !auses in!lude dry air, allergy$postnasal drip, !hemi!al injury, gastroesophageal reflux disease (/B'(), smoking, neoplasia, and endotra!heal intubation.
(emedicine.medscape.com)

PATOLOGI +ekitar ;23 kasus faringitis disebabkan "irus. +isanya disebabkan bakteri dan kandidiasis fungal (jarang terjadi, biasanya pada bayi). Euga dapat disebabkan iritasi akibat polusi senya a kimia. Pada faringitis akibat "irus, "irus berusaha menembus sel. sel mukosa yang melapisi nasofaring dan bereplikasi dalam sel.sel ini. /angguan pada penderita seringnya disebabkan oleh 2leh sel.sel dimana "irus bereplikasi. ?mumnya sembuh dengan sendirinya, tidak perlu pengobatan spesifik, dan jarang menimbulkan komplikasi. 8irus Bpstein.barr, herpes simplex, measle dan !ommon !oald. %akteri penyebab faringitis yang paling umum adalah kelompok & streptokokus. &da banyak strain; paling berbahaya strain %.hemolitik (/&%0+). %akteri lain yang juga umum adalah <oryneba!terium diphtheria, <hlamydia pneumonia dan stafilokokus. Eika tidak ditangani dalam ; hari, infeksi olek /&%0+ beresiko menimbulkan demam rematik. <oryneba!terium diphtheria tidak terlalu in"asi"e dan tetap terlokalisir pada permukaan saluran permukaan saluran pernapasan. 0anya lisogenik !oryneba!terium diphtheria tidak terlalu terlokalisasir pada permukaan sluran peranafasan. 0anya lisogenik <oryneba!terium diphtheria bakteriofag pemba a gen toksik yang memyebabkan difteria. Kerusakan pada faring disebabkan oleh toksin tersebut, yang membunuh sel.sel mukosa dan &(P.ribosylating alongation fa!tor ##. 5oksin juga dapat merusak jantung dan saraf. %akteri ini telah dieradikasi di Fegara.negara maju sejak dilakukannya program "aksinasi anak, tetapi masih dilaporkan dineraga.negara dunia ketiga dan makin meningkat dibeberapa daerah dieropa timur. &ntibioti! efektif dalam tahap a al, tapi penyembuhan biasanya lamban. +edangkan <hlamydia pnemoniae menyebabkan sekitar -3 infeksi, dengan onset sub akut dan faringitis.

Penderita sering mengalami pola bifasik, tetapi membaik sebelum berkembang menjadi bron!hitis atau pneumonia. (farmasiinfo.blogspot.com)

Pathophysiology
Gith infe!tious pharyngitis, ba!teria or "iruses may dire!tly in"ade the pharyngeal mu!osa, !ausing a lo!al inflammatory response. =ther "iruses, su!h as rhino"irus and !orona"irus, !an !ause irritation of pharyngeal mu!osa se!ondary to nasal se!retions.4 +trepto!o!!al infe!tions are !hara!teriCed by lo!al in"asion and release of extra!ellular toxins and proteases. #n addition, 7 protein fragments of !ertain serotypes of /&+ are similar to myo!ardial sar!olemma antigens and are linked to rheumati! fe"er and subseDuent heart "al"e damage. &!ute glomerulonephritis may result from antibody.antigen !omplex deposition in glomeruli.1 (emedicine.medscape.com)

A!IFE"TA"I#$LI!I"
%aik pada infeksi "irus maupun bakteri, gejalanya sama yaitu nyeri tenggorokan dan nyeri menelan. +elaput lendir yang melapisi faring mengalami peradangan berat atau ringan dan tertutup oleh selaput yang ber arna keputihan atau mengeluarkan nanah. /ejala lainnya adalah9 . demam . pembesaran kelenjar getah bening di leher . peningkatan jumlah sel darah putih. /ejala tersebut bisa ditemukan pada infeksi karena "irus maupun bakteri, tetapi lebih merupakan gejala khas untuk infeksi karena bakteri. %#&enis#faringitis Faringitis 8irus %iasanya tidak ditemukan nanah di tenggorokan (emam ringan atau tanpa demam Eumlah sel darah putih normal atau agak meningkat Kelenjar getah bening normal atau sedikit membesar 5es apus tenggorokan memberikan hasil negatif Pada biakan di laboratorium tidak tumbuh bakteri
(medicastore.com)

Faringitis %akteri +ering ditemukan nanah di tenggorokan (emam ringan sampai sedang Eumlah sel darah putih meningkat ringan sampai sedang Pembengkakan ringan sampai sedang pada kelenjar getah bening 5es apus tenggorokan memberikan hasil positif untuk strep throat %akteri tumbuh pada biakan di laboratorium

/ejala radang tenggorokan seringkali merupakan pratanda penyakit flu atau pilek. faringitis ada yang akut dan kronis,

Faringitis akut, radang tenggorok yang masih baru, dengan gejala nyeri tenggorok dan kadang disertai demam dan batuk. Faringitis kronis, radang tenggorok yang sudah berlangsung dalam aktu yang lama, biasanya tidak disertai nyeri menelan, !uma terasa ada sesuatu yang mengganjal di tenggorok. (id.wikipedia.org)

Penderita ditandai demam, sakit tenggorokan, edema, hyperemia pada tamsil dan dinding faringeal. Penderita faringitis /&%0+ umumnya mengalami nyeri berat saat menelan (umumnya onset tiba.tiba) dan demam. +akit kepala, mual, muntah dan nyeri perut juga dapat terjadi, khususnya pada anak. +aat dilakukan pemeriksaan, pasien memiliki eritema tonsilofaringeal, dengan atau tanpa eksudat, serta pembesaran nodus limfa anterior ser"iks (limfa denitis). 7ereka juga mungkin mengalami pembengkakan u"ula dengan arna kemerahan, pete!hiae pada palate, gangguan pada amandel (biasanya pada anak); dan ruam s!alantiniform. Famun, tak satupun temuan ini spesifik untuk faringitis /&%0+. Faringitis "iral biasa ditandai dengan temuan serupa. Konjugtifitis, batuk, serak, !oryCa, anterior stomatistis, lesi dis!rete ul!erati"e, "iral exanthema dan diare, umumnya lebih menga!u pada faringitis "iral dari pada /&%0+. +ementara untuk difteria, terdapat !irri khas yang perlu diperhatikan9 nyerifaringeal, pembentukan pseudomembran yang terlihat pada tonsil dan belakang tenggorok, limfadenopati regional (memberikan penampakan klasik bull ne!k), edema pada jaringan sekitar, nafar bau, demam derajat rendah dan btuk. =bstruksi pada jalan udara dapat terjadi bersamaan dengan ta!hypnea, stridor dan sianosis. 5oksin juga dapat men!apai neuron dan jantung, menyebabkan abnormallitas neurologis dan miokarditis. (farmasiinfo.blogspot.com) 5he main symptom is a sore throat. "ore#Throat# &lso !alled9 Pharyngitis Hour throat is a tube that !arries food to your esophagus and air to your indpipe and larynx. 5he te!hni!al name for throat is pharynx. Hou !an ha"e a sore throat for many reasons. =ften, !olds and flu !ause sore throats. =ther !auses !an in!lude9

&llergies 7ononu!leosis +moking +trep throat 5onsillitis . an infe!tion in the tonsils

5reatment depends on the !ause. +u!king on loCenges, drinking lots of liDuids and gargling may ease the pain. ="er.the.!ounter pain relie"ers !an also help, but !hildren should not take aspirin.

+tart 0ere o E&7& Patient Page9 +ore 5hroat(&meri!an 7edi!al &sso!iation)

=ther symptoms may in!lude9

"ever #eadache $oint pain and muscle aches

%&in rashes %wollen lymph nodes in the nec&

'haryngitis viral Symptoms (iscomfort when swallowing "ever

$oint pain or muscle aches %ore throat )ender, swollen lymph nodes in the nec& (www.nlm.nih.gov)

'istory
8iral and ba!terial !auses of pharyngitis are similar, and the differentiation of the etiology is diffi!ult based on history and physi!al examination alone. (espite this, !lassi! presentations are des!ribed belo .

/&+ infe!tion is most !ommon in !hildren aged A.> years. +udden onset is !onsistent ith a /&+ pharyngitis. Pharyngitis follo ing se"eral days of !oughing or rhinorrhea is more !onsistent ith a "iral etiology. Person has been in !onta!t ith others diagnosed ith /&+ or rheumati! fe"er. 0eada!he is !onsistent ith /&+ infe!tion. <ough is not usually asso!iated ith /&+ infe!tion. 8omiting is asso!iated ith /&+ infe!tion but may be present in other types of pharyngitis. & history of re!ent orogenital !onta!t suggests the possibility of gono!o!!al pharyngitis. & history of rheumati! fe"er is important hen !onsidering treatment.

5he <entor !riteria ha"e been used in the past as a ay to diagnose and treat /&+ pharyngitis. @ 5hese in!lude the follo ing9 Fe"er &nterior !er"i!al lymphadenopathy

5onsillar exudate &bsen!e of !ough

=ne point is a arded for ea!h of the !riteria met, ith patients s!oring 2., unlikely to ha"e /&+ infe!tion and patients ith a s!ore of A more likely to ha"e /&+. & !lini!al diagnosis of /&+ infe!tion using these !riteria !an result in an o"erestimation of the in!iden!e of strepto!o!!al pharyngitis, as many ba!terial and "iral !ases of pharyngitis !an be indistinguishable on !lini!al grounds. 5his !an lead to an o"ertreatment of pharyngitis ith antibioti!s.> #n adults, the positi"e predi!ti"e "alue of the <entor !riteria for predi!ting /&+ pharyngitis is around A23 if 1 !riteria are met, and about -23 if A !riteria are met.6 5hese !riteria should not be used alone to guide antibioti! therapy for pharyngitis in adults.

Physical

&ir ay paten!y must be assessed and addressed first.

5emperature9 Fe"er is usually absent or lo .grade in "iral pharyngitis, but fe"er is not reliable to differentiate "iral or ba!terial etiologies. 0ydration status9 =ral intake usually is !ompromised be!ause of odynophagia; therefore, "arious degrees of dehydration result. 0ead, ears, eyes, nose, and throat (0BBF5)
o o o o

<onjun!ti"itis may be seen in asso!iation ith adeno"irus. +!leral i!terus may be seen ith infe!tious mononu!leosis. 'hinorrhea usually is asso!iated ith a "iral !ause. 5onsillopharyngeal$palatal pete!hiae are seen in /&+ infe!tions and infe!tious mononu!leosis. & tonsillopharyngeal exudate may be seen in strepto!o!!al infe!tious mononu!leosis and o!!asionally in M pneumoniae, C pneumoniae, A haemolyticus, adeno"irus, and herpes"irus infe!tions. 5herefore, exudate does not differentiate "iral and ba!terial !auses. =ropharyngeal "esi!ular lesions are seen in !oxsa!kie"irus and herpes"irus. <on!omitant "esi!les on the hands and feet are asso!iated ith !oxsa!kie"irus (hand.foot.and.mouth disease).

Lymphadenopathy9 5ender anterior !er"i!al nodes are !onsistent ith strepto!o!!al infe!tion, hereas generaliCed adenopathy is !onsistent ith infe!tious mononu!leosis or the a!ute lymphoglandular syndrome of 0#8 infe!tion. <ardio"as!ular9 7urmurs should be do!umented in an a!ute episode of pharyngitis to monitor for potential rheumati! fe"er. Pulmonary9 Pharyngitis and lo er respiratory tra!t infe!tions are more !onsistent ith M pneumoniae or C pneumoniae, parti!ularly hen a persistent nonprodu!ti"e !ough is present. &bdomen9 0epatosplenomegaly !an be found in infe!tious mononu!leosis infe!tion. +kin
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& sandpapery s!arlatiniform rash is seen in /&+ infe!tion (see +!arlet Fe"er).; 7a!ulopapular rashes are seen ith "arious "iral infe!tions and ith infe!tious mononu!leosis empiri!ally treated ith peni!illin.

(emedicine.medscape.com)

DIAGNOSA
(iagnosis ditegakkan berdasarkan gejala dan hasil pemeriksaan fisik. Eika diduga suatu strep throat, bisa dilakukan pemeriksaan terhadap apus tenggorokan. (medicastore.com)
Exams and Tests

Hour health !are pro"ider ill perform a physi!al exam and look at your throat. 5ests to rule out strep throat may be done. &dditional laboratory tests may be done depending on the suspe!ted !ause. Pharyngitis 8iral

?sually the health !are pro"ider makes a diagnosis by examining the throat. & throat s ab !ulture ill be negati"e for ba!terial !auses of sore throat (su!h as group & strepto!o!!us). ( .nlm.nih.go")

(ork)p
Laboratory#"t)dies

/&%0+ rapid antigen dete!tion test

*apid#antigen#detection#test#for#gro)p#A#beta+hemolytic#streptococci.

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5his is the preferred method for diagnosing /&+ infe!tion in the emergen!y department be!ause of diffi!ulties ith !ulture follo .up. =nly patients ith a high !lini!al likelihood of /&+ pharyngitis should be tested. Patients ith a <entor s!ore of 2., should be treated symptomati!ally ithout testing.,2 &ntigens are spe!ifi!, but sensiti"ities "ary. <hildren ith a negati"e antigen test should ha"e a follo .up !ulture unless the antigen being used in the offi!e has been sho n to be as sensiti"e as a !ulture.; &dults do not need follo .up !ulture after a negati"e antigen test be!ause of the lo in!iden!e of /&+ in this population.,,

5hroat !ulture
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5his is the !riterion standard for diagnosis of /&+ infe!tion (;2.;;3 sensiti"e). &lthough less expensi"e than the rapid antigen dete!tion test, it is not be the best test to use in the emergen!y department be!ause of diffi!ulty ith follo .up. 5he guidelines that re!ommend !ultures for /&+ s!reening are aimed at offi!e.based pra!ti!es and not the emergen!y department. Patients !an be treated up to ; days after onset of symptoms to pre"ent a!ute rheumati! fe"er, so immediate antibioti! therapy is not !ru!ial if patients !an be easily !onta!ted for follo .up should a !ulture be!ome positi"e.,

7ono spot is up to ;-3 sensiti"e in !hildren (less than @23 sensiti"ity in infants). Peripheral smear may sho atypi!al lympho!ytes in infe!tious mononu!leosis.4 Perform gono!o!!al !ulture, as indi!ated by history. & !omplete blood !ount (<%<), erythro!yte sedimentation rate (B+'), and <.rea!ti"e protein ha"e a lo predi!ti"e "alue and usually are not indi!ated.

Imaging#"t)dies

#maging studies generally are not indi!ated for un!ompli!ated "iral or strepto!o!!al pharyngitis.

Lateral ne!k film should be taken in patients ith suspe!ted epiglottitis or air ay !ompromise. +oft tissue ne!k <5 should be used if !on!ern for abs!ess or deep.spa!e infe!tion exists.

Proced)res

5he pro!edure for a throat s ab is to "igorously rub a dry s ab o"er the posterior pharynx and both tonsils, obtaining a sample of exudate. #f any exudate is obtained, then transport it dry (not in a liDuid medium) (emedicine.medscape.com)

,IAG!O"I"#-A!,I!G <andidiasis Pediatri!s, 0and.Foot.and.7outh (isease (iphtheria Pediatri!s, Pharyngitis Bpiglottitis, &dult Pediatri!s, +!arlet Fe"er /onorrhea Peritonsillar &bs!ess 0erpes +implex Pharyngitis 7ononu!leosis Pneumonia, 7y!oplasma Pediatri!s, <roup or Laryngotra!heobron!hitis'etropharyngeal &bs!ess Pediatri!s, Bpiglottitis 'heumati! Fe"er
(emedicine.medscape.com)

T*EAT E!T ?ntuk mengurangi nyeri tenggorokan diberikan obat pereda nyeri (analgetik), obat hisap atau berkumur dengan larutan garam hangat. &spirin tidak boleh diberikan kepada anak.anak dan remaja yang berusia diba ah ,6 tahun karena bisa menyebabkan sindroma Reye. Eika diduga penyebabnya adalah bakteri, diberikan antibiotik. ?ntuk mengatasi infeksi dan men!egah komplikasi (misalnya demam rematik), jika penyebabnya streptokokus, diberikan tablet peni!illin. Eika penderita memiliki alergi terhadap peni!illin bisa diganti dengan erythromy!in atau antibiotik lainnya. Obat#Terkait &%%=5#< -22 7/. %B5&(#FB =%&5 K?7?' ,;2 7L %#<'=L#( %#F=KL&' <&P&%#=5#< <B<L=' K&P+?L <BFLBI <L&<#FB <L&P0&'7&
(medicastore.com)

<L&'=+ 4-2 <L='&<BF <L='&<BF <=75'= (B<&7B(#F (B/#'=L BF#+=L L=JBF/B+. B+PB<L=' F/ 5'=<0B+ 7B#E# F='#FBK

0B<=%&< KL&'#( 7B(#K=F<BF +BF5'#L +=<L=' K&P+?L +=L&F +P 5'=<0B+ 8B'<BF

Pengobatan dengan antibiotika hanya efektif apabila karena terkena kuman. Kadangkala makan makanan yang sehat dengan buah.buahan yang banyak, disertai dengan "itamin bisa menolong. (id.wikipedia.org)

#t is important to a"oid antibioti!s hen a sore throat is due to infe!tion ith a "irus. 5he antibioti!s ill not help. ?sing them to treat "iral infe!tions helps strengthen ba!teria to be!ome resistant to antibioti!s. 7ost sore throats are soon o"er. #n the meantime, the follo ing remedies may help9

(rin& warm li*uids. #oney or lemon tea is a time tested remedy. Gargle several times a day with warm salt water (+,- tsp of salt in + cup water). (rin& cold li*uids or suc& on popsicles. %uc& on hard candies or throat lo.enges to soothe your sore throat. )his is often as effective as more e/pensive remedies. (O 0O) use candies or lo.enges in young children !ecause of the cho&ing ris&. 1se a cool mist vapori.er or humidifier to moisten and soothe a dry and painful throat. )ry over the counter pain medications, such as acetaminophen. (O 0O) give aspirin to children.

'#A230G4)4% V42A5

5here is no spe!ifi! treatment for "iral pharyngitis. Hou !an relie"e symptoms by gargling ith arm salt ater (one half.teaspoon of salt in a glass of arm ater) se"eral times a day and taking anti.inflammatory drugs or medi!ations, su!h as a!etaminophen, to !ontrol fe"er. Bx!essi"e use of anti.inflammatory loCenges or sprays may make a sore throat orse. #t is important to a"oid antibioti!s hen a sore throat is due to a "iral infe!tion. 5he antibioti!s ill not help. ?sing them to treat "iral infe!tions helps strengthen ba!teria to be!ome resistant to antibioti!s. #n some sore throats (su!h as infe!tious mononu!leosis), the lymph nodes in the ne!k may be!ome extremely s ollen. 5hey may be treated ith anti.inflammatory drugs, su!h as prednisone. ( .nlm.nih.go")

Prehospital#.are

Prehospital !are usually is not ne!essary for un!ompli!ated pharyngitis unless air ay !ompromise is an issue. #ntubation should not be attempted unless the patient stops breathing spontaneously.

Emergency#,epartment#.are

&ssess and se!ure the air ay, if ne!essary. &ssess the patient for signs of toxi!ity, epiglottitis, or oropharyngeal abs!ess.,4 B"aluate the hydration status be!ause se"ere pharyngitis limits oral intake. &ppropriate measures to rehydrate should be initiated, in!luding intra"enous hydration. &ssess for /&+ infe!tion if !lini!ally suspe!ted. & suggested algorithm as is follo s.
o

#n general, patients should not be treated ithout a positi"e !ulture or positi"e rapid antigen dete!tion test result be!ause of in!reasing antibioti! resistan!e. /uidelines from the #nfe!tious (iseases +o!iety of &meri!a (#(+&) and &meri!an 0eart &sso!iation state that mi!robiologi! !onfirmation ("ia a rapid

antigen test or !ulture) is reDuired for the diagnosis of /&+.>,- Fe re!ommendations for pharyngitis therapy are due from the #(+& later in 422;.
o

Perform rapid antigen dete!tion test if /&+ is !lini!ally suspe!ted based on history and physi!al examination. #f positi"e, begin antibioti! therapy. 5esting does not usually need to be performed on patients ith a!ute pharyngitis hose !lini!al and epidemiologi! features do not suggest /&+ as the etiology (<entor s!ore 2.,).,, 0ousehold !onta!ts of patients ith /&+ infe!tion or s!arlet fe"er should be treated for a full ,2 days ithout testing only if they ha"e symptoms !onsistent ith /&+.#f !lini!ally doubtful or the abo"e !riteria are not met, it is best to a ait rapid antigen or !ulture results to initiate antibioti! therapy.

.ons)ltations
Gith a fe ex!eptions, un!ompli!ated !ases of pharyngitis should not reDuire a !onsultation. #nfe!tious disease spe!ialists should be !onsulted in the !ase of unusual presentation or in the !ase of a patient ho is immuno!ompromised.

edication
/&+ pharyngitis is usually a self.limited disease, and most signs and symptoms resol"e spontaneously in 1.A days. #f administered early, antibioti!s !an shorten the duration of the illness by up to , day, but the main reason they are gi"en is for pre"ention of a!ute rheumati! fe"er.,1 5his rationale is being Duestioned by many as the in!iden!e of a!ute rheumati! fe"er in the ?nited +tates is extremely lo . &ntibioti!s do not pre"ent a!ute glomerulonephritis. +teroids may be used for air ay !ompromise and symptomati! relief.,A &ntifungals and anti"irals are used in !ertain rare !ases ith spe!ialist !onsultation.

Antibiotics
Bmpiri! antimi!robial therapy must be !omprehensi"e and should !o"er all likely pathogens in the !ontext of the !lini!al setting. &ntibioti!s are indi!ated for !lini!ally suspe!ted and !ulture or antigen."erified /&+ infe!tion. 5hey are effe!ti"e in pre"enting rheumati! fe"er if gi"en ithin ; days of the onset of pharyngitis. =f note, some experts Duestion the use of antibioti!s for the treatment of /&+ infe!tion in the Gestern orld be!ause of the lo pre"alen!e of rheumati! fe"er. +ome Buropean guidelines for the treatment of pharyngitis only re!ommend antibioti!s for patients ith !ulture.positi"e /&+ pharyngitis ho are high.risk for a!ute rheumati! fe"er or "ery ill.,- =ne study suggested that obser"ation alone as most !ost.effe!ti"e strategy for /&+ pharyngitis in !hildren, and this strategy also had lo er morbidity and mortality than antibioti! treatment groups.,@ For no , most experts in the ?nited +tates still re!ommend treatment ith antibioti!s. +ome support the use of !ephalosporins instead of peni!illin as first.line therapy for /&+.,>,,6 5hey !ite literature that sho s greater eradi!ation of the ba!teria in the pharynx after treatment ith a !ephalosporin. Fo e"iden!e suggests that this is !lini!ally signifi!ant, and most guidelines still ad"o!ate that peni!illin is still the drug of !hoi!e for /&+ in the ?nited

+tates. 5here has ne"er been a !lini!al isolate of /&+ do!umented to be resistant to peni!illin any here in the orld.> #n !ases of !lini!al treatment failure of /&+ pharyngitis after peni!illin therapy, a !ephalosporin or broader.spe!trum peni!illin (ampi!illin.sulba!tam) should be !onsidered, but these instan!es are rare.,4 <ephalosporins should be !onsidered first.line therapy if the patient has a history of re!ent antibioti! usage, re!urrent pharyngitis infe!tion, a peni!illin allergy, or if a high failure rate of peni!illin is do!umented in the !ommunity.,; +ome !ontro"ersy exists regarding the treatment of !arriers of /&+. 5hese are patients ho ha"e a positi"e rapid antigen or !ulture ithout symptoms of pharyngitis. #t is belie"ed that this !arrier state does not lead to a!ute rheumati! fe"er or other !ompli!ations of /&+ pharyngitis. 7ost !arriers should not be treated; ho e"er, treatment should be !onsidered in !arriers ith the follo ing !hara!teristi!s9

'e!urrent pharyngitis ithout !ough or !ongestion &!ute rheumati! fe"er (&'F) or poststrepto!o!!al glomerulonephritis outbreaks /&+ pharyngitis in !losed !ommunity Family history of &'F 7ultiple do!umented /&+ pharyngitis episodes ithin a family o"er se"eral eeks despite therapy

#f !arriers are treated, !lindamy!in for ,2 days or #7 peni!illin plus A days of rifampin are re!ommended treatment options.42 Ghile some literature exists to support the use of a shorter !ourse of antibioti! therapy for /&+ pharyngitis, most international guidelines still re!ommend a ,2.day !ourse for most antibioti!s.4, 5his may !hange shortly as ne guidelines are due in 422; from the #nfe!tious (iseases +o!iety of &meri!a (#(+&).

Penicillin#G#ben/athine#0-icillin#LA) #nhibits biosynthesis of !ell all mu!opeptide. %a!teri!idal against sensiti"e organisms hen adeDuate !on!entrations rea!hed, and most effe!ti"e during stage of a!ti"e multipli!ation. #nadeDuate !on!entrations may produ!e only ba!teriostati! effe!ts. +till is drug of !hoi!e in /&+ pharyngitis be!ause of its narro spe!trum of a!ti"ity, lo !ost, and pro"en safety tra!k re!ord. #7 peni!illin is drug of !hoi!e in patients here !omplian!e is an issue be!ause of single dose.#(emedicine.medscape.com)

FOLLO(#1P

F)rther#Inpatient#.are

#npatient !are usually is not indi!ated ex!ept in !ases su!h as epiglottitis, se"ere dehydration, deep.spa!e infe!tion, other air ay !ompromise, or diphtheria.

F)rther#O)tpatient#.are

Follo .up for /&+ pharyngitis

& standardiCed proto!ol needs to be established at ea!h institution or B( to ensure follo .up for patients ith pending throat !ultures. 5his is parti!ularly !hallenging ith unreliable patients and ith a shift.dependent B( pra!ti!e. Ghether or not they are gi"en antibioti!s, patients diagnosed ith pharyngitis should follo up if symptoms do not impro"e ithin >4 hours. 'outine posttreatment throat !ultures are unne!essary and may remain positi"e for se"eral eeks., & follo .up !ulture should be taken if history or e"iden!e of rheumati! fe"er or if symptoms are !onsistent ith a relapse.,;

Patients ith infe!tious mononu!leosis should be instru!ted to follo up ith their physi!ian in , eek. 5hese patients should also be ad"ised to a"oid !onta!t sports.; 8iral pharyngitis generally reDuires no spe!ifi! follo .up unless immunosuppression is suspe!ted or symptoms orsen. Patients ith suspe!ted malignan!y should be referred to an otolaryngologist for follo .up.

Transfer

5ransfer usually is not ne!essary for simple a!ute pharyngitis. 5he air ay should be e"aluated and endotra!heal intubation should be performed prior to transfer if a high probability of !ompromise exists during transfer.#
(emedicine.medscape.com)

P*OG!O"I"
most !ases of pharyngitis go a ay on their o n ithout !ompli!ations. 8#'&L +ymptoms usually go a ay ithin a eek to ,2 days. ( .nlm.nih.go")

Prognosis

7ost !ases of pharyngitis resol"e spontaneously ithin ,2 days, but it is important for the !lini!ian to be a are of potential !ompli!ations listed abo"e. 5reatment failures are freDuent and are attributed mainly to poor !omplian!e, antibioti! resistan!e, untreated !lose !onta!ts, !arrier states, and antibioti!.related or !opathogeni! suppression of host immunity and ne!essary flora.A =f note, /&+ resistan!e to peni!illin is F=5 thought to be a reason for treatment failures ith peni!illin. Patients should expe!t impro"ement in symptoms in peni!illin.sensiti"e strepto!o!!al pharyngitis ithin 4A hours of initiation of treatment. <ontagious and often the febrile periods also are redu!ed to , day. Gith erythromy!in therapy, patients should expe!t impro"ement in >4 hours. 5he in!iden!e of strepto!o!!al resistan!e to erythromy!in may ex!eed 123.> 5herefore, patients on erythromy!in therapy should be more !losely monitored for treatment failure. (emedicine.medscape.com)

$O PLI$A"I
<ompli!ations of pharyngitis may in!lude9

Bloc&age of the airway (in severe cases) %ore (a!scess) around the tonsils or !ehind the pharyn/

<ompli!ations of "iral pharyngitis are extremely un!ommon. (

.nlm.nih.go")

.omplications

/eneral !ompli!ations of pharyngitis (mainly seen in !ases of ba!terial pharyngitis) in!lude sinusitis, otitis media, epiglottitis, mastoiditis, and pneumonia. o +uppurati"e !ompli!ations of ba!terial pharyngitis result from spread of infe!tion from pharyngeal mu!osa "ia hematogenous, lymphati!, or dire!t extension (more !ommon ith /&+); peritonsillar abs!ess; retropharyngeal abs!ess; or suppurati"e !er"i!al lymphadenitis. #t is un!lear if antibioti! therapy !an pre"ent these !ompli!ations as abs!ess isolates are often polymi!robial. 7any experts belie"e these are a!tually independent entities and not related to /&+ pharyngitis. #n addition to the abo"e general !ompli!ations, nonsuppurati"e !ompli!ations (13 in!iden!e) spe!ifi! to /&+ infe!tion in!lude a!ute rheumati! fe"er (1.- k postinfe!tion), poststrepto!o!!al glomerulonephritis, and toxi! sho!k syndrome. <ompli!ations of infe!tious mononu!leosis in!lude spleni! rupture (!onta!t sports should be a"oided for @ k), hepatitis, /uillain.%arrK syndrome, en!ephalitis, hemolyti! anemia, agranulo!ytosis, myo!arditis, %.!ell lymphoma, and nasopharyngeal !ar!inoma. ?se of peni!illin in !ases of infe!tious mononu!leosis results in near ,223 in!iden!e of rash.; (emedicine.medscape.com)

P*E2E!"I
,eterrence3Pre4ention

5hroat !ultures should be obtained on !lose !onta!ts of patients ith a history of a nonsuppurati"e !ompli!ation (a!ute rheumati! fe"er) of a strepto!o!!al infe!tion or if re!urrent outbreaks of /&+ pharyngitis o!!ur.(iphtheria immuniCation is highly effe!ti"e and re!ommended for nonimmuniCed patients to redu!e potential morbidity and mortality of the disease.

Patient#Ed)cation

Patients must be instru!ted to !omplete the full !ourse of antibioti! therapy, as impro"ement may o!!ur rapidly. Patients should be instru!ted to follo up hen indi!ated (see Further =utpatient <are). Patients ith infe!tious mononu!leosis should be instru!ted to a"oid !onta!t sports for a period of @ eeks be!ause of the possibility of spleni! rupture.

Patients should be edu!ated about symptomati! treatment of pharyngitis.

o o

#buprofen or a!etaminophen is re!ommended for analgesia. +alt ater gargle, arm liDuids, and rest may be helpful in relie"ing symptoms.

For ex!ellent patient edu!ation resour!es, "isit e7edi!ineLs %a!terial and 8iral #nfe!tions <enter. &lso, see e7edi!ineLs patient edu!ation arti!les +ore 5hroat and 7ononu!leosis. (emedicine.medscape.com)

7ost !ases are not pre"entable, be!ause the "iruses and ba!teria that !ause sore throats are !ommonly found in the en"ironment. 0o e"er, al ays ash your hands after !onta!t ith a person ho has a sore throat. &"oid kissing or sharing !ups and eating utensils ith si!k indi"iduals. ( .nlm.nih.go")