Group A streptococcal pharyngitis Diagnosis and management Rapid antigen detection test Obtain a rapid antigen detection test for GAS pharyngitis in most patients with symptoms of acute pharyngitis because the clinical features alone do not reliably discriminate between group A streptococcal and viral pharyngitis, except when overt viral features such as rhinorrhea, cough, oral ulcers, and/or hoarseness are present. A Do not test for GAS pharyngitis in pediatric or adult patients with acute pharyngitis with clinical and epidemiological features strongly suggesting a viral etiology. D Do not test for GAS pharyngitis in < 3 years old pediatric patients because acute rheumatic fever is rare in this age group and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon. Consider testing selected patients of this age group in the presence of risk factors, such as an older sibling with group A streptococcal infection. D Throat culture IDSA Q Is the patient an adolescent or child? Yes Obtain a throat culture in pediatric and adolescent patients if the rapid antigen detection test is negative. Do not obtain throat cultures if the rapid antigen detection test is positive. A No Avoid routine use of back-up throat cultures for adults with a negative rapid antigen detection test. D Antibiotic therapy IDSA Q Does diagnostic testing confirm GAS pharyngitis? No Consider alternative diagnoses. Yes Initiate an appropriate antibiotic (penicillin or amoxicillin as the drug of choice if not allergic to these agents) at an appropriate dose for a duration likely to eradicate the organism from the pharynx (usually 10 days). A Initiate any of the following regimens in penicillin-allergic patients: a first-generation cephalosporin (if not anaphylactically sensitive) for 10 days clindamycin or clarithromycin for 10 days azithromycin for 5 days. B Analgesics Consider offering analgesic/antipyretic agents (such as acetaminophen or NSAIDs) as adjunctive therapy for the treatment of moderate-to-severe symptoms or control of high fever associated with GAS pharyngitis. B Avoid using aspirin in pediatric patients with GAS pharyngitis. D Corticosteroids Do not offer corticosteroids as adjunctive therapy in patients with GAS pharyngitis. D Post-treatment throat culture Do not obtain routine follow-up post-treatment throat cultures or rapid antigen detection tests; consider these only in special circumstances. D Indications for testing (asymptomatic contacts) Do not obtain routine testing in asymptomatic household contacts of patients with acute GAS pharyngitis. D