Oct 31, 2016
Dr. Robert Centor’s Knowledge
Food, Part 2! 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. Not only do we learn how to dominate pharyngitis,
but we also uncover one of Dr. Watto’s knowledge deficits -
Lemierre’s Syndrome. (He owes us a two minute talk on
Lemierre’s Syndrome in case you’re wondering. I know I
your own limitations! Many overestimate their skills as a
- Preadolescents get streptococcal pharyngitis
(...or it’s nothing).
- Adolescents are much more complicated with
streptococcus, EBV, CMV, acute HIV, fusobacterium, and multiple
- 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
NOT miss a peritonsillar abscess or Lemierre’s Syndrome in acute
- Pharyngitis improves within three to five days.
Failure to improve should prompt a more thorough
- Lemierre’s Syndrome (1 in 70,000 untreated
pharyngitis patients) is septic thrombophlebitis of the internal
jugular vein. The treatment is IV antibiotics and NOT
Centor and the IDSA recommends Amoxicillin once daily and, if
penicillin allergic, Clindamycin. The most recent IDSA update
recommends a 10-day course of Amoxicillin (50mg/kg up to 1000mg
Dr. Centor’s “Take-Home” Points:
- Adolescents tend to have more complicated
- Pharyngitis and rigors? Admit, obtain
cultures, and start antibiotics.
throats don’t get worse and, if they do, you need to rethink the
Dr. Centor reports no relevant
financial disclosures for this topic.
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
able to identify Amoxicillin as the treatment of choice for acute
bacterial pharyngitis with Clindamycin as the second-line
Links from the show:
our Dr. Centor’s wonderful blog, at http://www.medrants.com or on twitter https://twitter.com/medrants
- Centor’s Criteria (MDCalc) --
Guidelines on Diagnosis and Management of Group A Streptococcus
- Original article using the Centor score for
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.