I enjoyed Dr. Matt Bivens' article on pharyngitis in the December issue. (EMN. 2022;44[12:22; http://bit.ly/3VFCWXB.)
Can I correctly assume that there are few clinical features that will help distinguish Fusobacterium necrophorum from strep? I try to be a good steward of antibiotic usage, but this article will likely change my practice and liberalize my use of antibiotics given the information provided.
When my clinical suspicion is high for strep, I typically use penicillin V because this is the drug of choice. Is this also effective against F. necrophorum? (I typically work a fair amount of telemedicine and do not have rapid testing available.)
Thank you again for the article.
Henry Arst, MD
Overland Park, KS
Dr. Bivens responds: Thank you for your letter. It is indeed challenging to see a clinical difference between the pharyngitis caused by group A strep and that caused by F. necrophorum. They present in similar fashion. It is possible to use the Centor criteria and simply treat empirically for both, especially when the age range is right—roughly 15 to 45—and the Centor scores are calculating out high, in the 4s or 5s. (So that would mean fever, exudates, lymphadenopathy, absence of cough, and the right age range; you can run the score on MDCalc at https://bit.ly/3S6XINv.) Penicillins, including good old cheap penicillin V, will cover group A strep and F. necrophorum. Cephalosporins probably cover both as well, although data are lacking. Importantly, azithromycin does not cover F. necrophorum.