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SAMPLE

STREP THROAT

A. Diagnostic Criteria:

A. Diagnostic Criteria:

1. Each diagnosis is defined by a set of signs, symptoms and tests results which must be taken together to establish the specific diagnosis
2. There may be several pathways to a given diagnosis.*

1. Positive Throat culture or rapid strep test
   or
2. Sore throat and household contact to a patient with positive strep test.

B. Laboratory:

B. Laboratory:

This states all the lab tests, x-rays, etc., that are required on a patient with this diagnosis. Some of the tests may be necessary to establish the diagnosis.

Rapid Strep Test

C. Treatment:

C. Treatment:

This contains specific instructions for treatment of patients with this diagnosis. These are standing orders and should be clear and complete written orders.

1. Amoxicillin 500 mg TID x 10
   or
2. Erythromycin 250 mg QID x 10
   (Use the dose protocol for children)

D. Follow-Up:

D. Follow-Up:

All patients should be given a return appointment and specific instructions for follow-up.

1. Return to clinic if not improved in 48 hours
2. Dipstick urine for protein in 6 weeks.

E. Epidemiology:

E. Epidemiology:

This authorizes treatment of contacts to the patient and specifies if the disease is reportable to the public health authority or the police.

1. Treat all symptomatic family members if anyone has a positive lab test for strep
2. Scarlet fever must be reported to the health department.

F. When to Refer:

F. When to Refer:

This states the severity of disease or the special circumstances that require referral to a different protocol, to the supervising physician, to the Emergency Room, or for other services. This defines the scope of practice for the nurse.

1. If Otitis Media is present, use that protocol
2. Consult physician if scarlet fever rash is present or if the patient cannot take either antibiotic
3. Refer to the ER any patient with airway compromise or peritosilar abscess.

G. Notes:

G. Notes:

This portion of the protocol is not binding on the providers. This is the place for clinical pearls and helpful hints.

* Differential diagnosis is not part of a strict protocol and should not be used.

1. Office strep tests are only 50% to 70% sensitive
2. There is no set of signs and symptoms that reliably distinguishes strep throat from viral pharyngitis.