Definition. Group A streptococcal pharyngitis (pharyngotonsillitis)
is an acute infection of the oropharynx and/or nasopharynx
that is caused by Streptococcus pyogenes.
Objectives. The objective of this practice guideline is to
provide recommendations for the accurate diagnosis and optimal
treatment of group A streptococcal pharyngitis in children
and in adults.
Options. The physician caring for a patient with acute
pharyngitis must formulate a differential diagnosis and determine
which, if any, confirmatory tests should be performed.
Should clinical and laboratory evaluation result in a diagnosis
of group A b-hemolytic streptococcal pharyngitis, penicillin
remains the drug of choice for treatment. For the patient allergic
to penicillin, several alternative antimicrobial agents are
available.
Outcomes. The desired outcomes are as follows: prevention
of acute rheumatic fever; prevention of suppurative complications
(e.g., peritonsillar abscess, cervical lymphadenitis,
and mastoiditis); improvement in clinical symptoms and signs;
rapid decrease in infectivity, to reduce transmission of group
A b-hemolytic streptococci to family members, classmates, and
other close contacts of the patient, and to allow the rapid resumption
of usual activities; and minimization of potential
adverse effects of inappropriate antimicrobial therapy.