A Nurse is Caring for a Client Who has Streptococcal Pharyngitis and an Allergy to Penicillin

As a nurse caring for a client who has both streptococcal pharyngitis and an allergy to penicillin, I am faced with the challenge of managing their condition effectively while avoiding potential complications. Streptococcal pharyngitis, commonly known as strep throat, is a bacterial infection that can cause discomfort and pain in the throat. It is important to promptly diagnose and treat this condition to prevent further complications.


  • Streptococcal Pharyngitis is mainly caused by the group A streptococcus bacteria. It spreads through airborne droplets when an infected person coughs or sneezes.
  • Direct contact with surfaces contaminated by these bacteria can also lead to transmission. Sharing utensils or personal items with an infected individual increases the risk of contracting strep throat.
  • Crowded environments like schools or daycare centers can facilitate the spread of infection, especially among children.


  • Sore throat: One of the primary signs of strep throat is a severe and persistent sore throat that makes swallowing painful.
  • Red and swollen tonsils: The tonsils may appear inflamed, often accompanied by white patches or streaks of pus.
  • Difficulty swallowing: Due to inflammation in the throat, individuals may experience difficulty swallowing food or liquids.
  • Fever: Strep throat can cause a high fever (over 101 degrees Fahrenheit) which may be accompanied by chills and body aches.
  • Headache: Some people with strep throat may experience headaches along with other flu-like symptoms such as fatigue and malaise.
  • Swollen lymph nodes: The glands in the neck may become tender and swollen due to an immune response to fight off the bacterial infection.

Complications of Streptococcal Pharyngitis

When it comes to streptococcal pharyngitis, the potential complications can be quite concerning. While this common bacterial infection usually leads to a sore throat and discomfort, it’s important for nurses to be aware of the possible complications that can arise if left untreated or improperly managed.

  1. Rheumatic Fever: One of the most significant complications associated with streptococcal pharyngitis is the development of rheumatic fever. This autoimmune disease primarily affects children and adolescents and can lead to inflammation in various parts of the body, including the heart, joints, skin, and brain. If not detected and treated promptly, rheumatic fever can cause long-term damage to these organs.
  2. Scarlet Fever: Another potential complication is scarlet fever, which is caused by certain strains of streptococcus bacteria that produce toxins. This condition typically presents with a characteristic rash that spreads across the body, along with a high fever and a strawberry-like appearance of the tongue. While scarlet fever is generally considered less severe than rheumatic fever, it still requires medical attention to prevent any further complications.
  3. Post-Streptococcal Glomerulonephritis: In some cases, streptococcal pharyngitis can also lead to post-streptococcal glomerulonephritis (PSGN), an inflammatory condition affecting the kidneys’ filtering units called glomeruli. PSGN typically occurs around one to three weeks after an initial strep infection and may present with symptoms such as blood in urine, swelling around the eyes or ankles, and high blood pressure.
  4. Sinusitis and Ear Infections: Untreated or recurrent strep throat infections can also increase the risk of secondary infections such as sinusitis (inflammation of sinuses) or ear infections (otitis media). These conditions can cause additional discomfort and may require antibiotic treatment to resolve.
  5. Abscess Formation: In rare cases, streptococcal pharyngitis can lead to the formation of abscesses in the throat. These pockets of pus can cause severe pain, difficulty swallowing, and even compromise the airway if left untreated. Prompt medical intervention is crucial to drain the abscess and administer appropriate antibiotics.

Understanding Penicillin Allergy

Let’s dive into the topic of penicillin allergy and explore its implications for individuals with streptococcal pharyngitis. When a nurse is caring for a client who has both streptococcal pharyngitis and an allergy to penicillin, it is crucial to understand the potential complications that may arise. Here are some key points to consider:

  1. The Prevalence of Penicillin Allergy: Penicillin is one of the most commonly prescribed antibiotics. However, studies suggest that up to 10% of the population reports being allergic to penicillin. It’s important to note that not all reported allergies are true allergies, as many individuals may have experienced non-allergic reactions or confusion between side effects and allergic responses.
  2. Manifestations of Penicillin Allergy: A true penicillin allergy can range from mild skin rashes and hives to severe reactions like anaphylaxis, a life-threatening condition characterized by difficulty breathing, swelling, and low blood pressure. It’s essential for nurses to be vigilant in recognizing any signs or symptoms of an allergic reaction when administering medications or providing care.
  3. Alternative Antibiotics: Due to the risk associated with administering penicillin to individuals with a documented allergy, alternative antibiotics must be considered in cases of streptococcal pharyngitis. There are several antibiotic options available, such as macrolides (e.g., erythromycin) or cephalosporins (e.g., cephalexin), which can effectively treat this bacterial infection without triggering an allergic response.
  4. Communicating Allergies Effectively: Nurses play a crucial role in ensuring accurate documentation and communication regarding patients’ allergies throughout their healthcare journey. This includes updating medical records promptly and communicating the allergy information clearly during handoffs between healthcare providers.