Key Points
����Group A ��-hemolytic streptococcus (GAS) is the most common bacterial
cause of acute pharyngitis, responsible for 5%-15% of sore throat visits in
adults and 20%-30% in children.
����Although acute pharyngitis is one of the most frequent illnesses for which
pediatricians and other primary care physicians are consulted, with an
estimated 15 million visits per year in the U.S., only a relatively small
percentage of patients with acute pharyngitis (20%-30% in children, fewer
in adults) are infected by GAS pharyngitis.
����Moreover, the signs and symptoms of GAS and nonstreptococcal pharyngitis
overlap so broadly that accurate diagnosis on clinical grounds alone is
usually impossible.
����Accurate diagnosis of streptococcal pharyngitis followed by appropriate
antimicrobial therapy is important:
������ to prevent acute rheumatic fever with and without carditis
������ to prevent suppurative complications (e.g., peritonsillar abscess, cervical lymphadenitis,
mastoiditis and possibly other invasive infections)
������ to improve clinical symptoms and signs
������ for rapid decrease in contagiousness
������ to reduce transmission of GAS to family members, classmates, and other close contacts
of the patient
������ to allow for the rapid resumption of usual activities
������ to minimize potential adverse effects of inappropriate antimicrobial therapy.
����Penicillin or amoxicillin remains the treatment of choice, and azithromycin,
clarithromycin, clindamycin or a 1st generation cephalosporin a for the
penicillin-allergic patient.
����With the exception of very rare infections by certain other bacterial
pharyngeal pathogens (e.g., Corynebacterium diphtheriae and Neisseria
gonorrhoeae) (Table 2), antimicrobial therapy is of no proven benefit as
treatment for acute pharyngitis due to organisms other than Group A
streptococci.
Therefore, it is extremely important that physicians confirm the diagnosis of GAS
pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of
patients with non-streptococcal pharyngitis.
a
Unless reaction to a penicillin was anaphylactic.
