Treatment
����Patients with acute GAS pharyngitis should be treated with an
appropriate antibiotic at an appropriate dose for a duration likely to
eradicate the organism from the pharynx (usually 10 days).
Based on their narrow spectrum of activity, infrequency of adverse reactions, and modest
cost, penicillin or amoxicillin is the recommended drug of choice for those not allergic to
these agents (SR-H).
����Treatment of GAS pharyngitis in penicillin-allergic individuals should
include a first generation cephalosporin (for those not anaphylactically
sensitive) for 10 days, clindamycin or clarithromycin for 10 days, or
azithromycin for 5 days (SR-M).
����Adjunctive therapy may be useful in the management of GAS pharyngitis.
������ If warranted, use of an analgesic/antipyretic agent such as acetaminophen or an
NSAID for treatment of moderate to severe symptoms or control of high fever
associated with GAS pharyngitis should be considered as an adjunct to an appropriate
antibiotic (SR-H).
������ Aspirin should be avoided in children (SR-M).
������ Adjunctive therapy with a corticosteroid is NOT recommended (WR-M).
����The IDSA recommends that clinicians caring for patients with recurrent
episodes of pharyngitis associated with laboratory evidence of GAS
pharyngitis consider that they may be experiencing > 1 episode of bona
fide streptococcal pharyngitis at close intervals, but they should also
be alert to the possibility that the patient may actually be a chronic
pharyngeal GAS carrier who is experiencing repeated viral infections
(SR-M).
����The IDSA recommends that identifying GAS carriers is not ordinarily
justified, nor do GAS carriers generally require antimicrobial therapy,
because GAS carriers are unlikely to spread GAS pharyngitis to their
close contacts and are at little or no risk for developing suppurative or
non-suppurative complications (e.g., acute rheumatic fever) (SR-M).
����The IDSA does NOT recommend tonsillectomy solely to reduce the
frequency of GAS pharyngitis (SR-H).
