Streptococcal Pharyngitis

IDSA Strep Throat Guidelines

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Diagnosis Key Points ����Swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture should be performed because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers and/or hoarseness are present. ������ In children and adolescents, negative RADT tests should be backed up by a throat culture (SR-H). Positive RADTs do not necessitate a back-up culture because they are highly specific (SR-H). ����Routine use of back up throat cultures for those with a negative RADT is not necessary for adults in usual circumstances because there is a low incidence of GAS pharyngitis in adults and the risk of subsequent acute rheumatic fever is generally exceptionally low in adults with acute pharyngitis (SR-M). Physicians who wish to��ensure they are achieving maximal sensitivity in diagnosis may continue to use conventional throat culture or to back up negative RADTs. ����Anti-streptococcal antibody titers are not recommended in the routine diagnosis of acute pharyngitis since they reflect past but not current events (SR-H). ����Testing for GAS pharyngitis usually is not recommended for children or adults with acute pharyngitis with clinical and epidemiologic features that strongly suggest a viral etiology (e.g., cough, rhinorrhea, hoarseness, and oral ulcers) (SR-H). ����Diagnostic studies for GAS pharyngitis are not indicated for children < 3 years old because acute rheumatic fever is rare in these children and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group. Selected children < 3 years old who have other risk factors such as an older sibling with GAS infection may be considered for testing (SR-M). ����Follow-up post-treatment throat culture or RADT is not recommended routinely but may be considered in special circumstances (SR-H). ����Diagnostic testing or empiric treatment of asymptomatic household contacts of patients with acute streptococcal pharyngitis is not routinely recommended (SR-M).

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