Table of contents
Group A streptococcal pharyngitis
What's new
Updated 2024 AAFP guidelines for the diagnosis and management of group A streptococcal pharyngitis.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of group A streptococcal pharyngitis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2023), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2019), the American Academy of Pediatrics (AAP 2018), the British Medical Journal (BMJ 2017), the American College of ...
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Screening and diagnosis
Indications for testing, symptomatic patients: as per ACP/CDC 2016 guidelines, obtain rapid antigen detection test and/or culture for group A Streptococcus in patients with symptoms suggestive of GAS pharyngitis (such as persistent fever, anterior cervical lymphadenopathy, and tonsillar/pharyngeal exudate, or other appropriate combination of symptoms).
B
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Indications for testing (asymptomatic contacts)
Diagnosis
Classification and risk stratification
Diagnostic investigations
Rapid antigen detection test: as per AAFP 2023 guidelines, consider obtaining rapid antigen detection testing in patients with a Centor score of ≥ 2.
B
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Throat culture
Anti-streptococcal antibodies
Inflammatory markers
Medical management
Antibiotic therapy
As per AAFP 2024 guidelines:
Initiate penicillin or amoxicillin as the first-line antibiotic for GAS pharyngitis.
A
Do not use azithromycin GAS pharyngitis unless the patient is allergic to β-lactams.
D
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Analgesics
Corticosteroids
Zinc gluconate
Nonpharmacologic interventions
Surgical interventions
Specific circumstances
Chronic group A streptococcal carriers
As per IDSA 2012 guidelines:
Recognize that recurrent episodes of pharyngitis in patients with laboratory evidence of group A streptococcal infection may represent either:
multiple episodes of bona fide recurrent streptococcal pharyngitis at close intervals, or
multiple episodes of viral pharyngitis in chronic pharyngeal group A streptococcus carriers
B
Do not attempt to identify nor administer antimicrobial therapy in patients with asymptomatic group A streptococcus carriage, as they are unlikely to spread GAS pharyngitis to their close contacts and are at little or no risk for developing suppurative or non-suppurative complications, such as acute rheumatic fever.
D
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Asymptomatic household contacts