Diagnosis and treatment of group A streptococcal pharyngitis

Abstract

Although clinical and epidemiological findings suggest group A beta-hemolytic streptococci (GABHS) as the cause of an episode of acute pharyngitis, the diagnosis must rely on bacteriologic confirmation (either a throat culture or rapid antigen detection test). Penicillin is the drug of choice for the treatment of pharyngitis caused by GABHS; erythromycin is indicated for those who are allergic to penicillin. Many of the newer cephalosporins and macrolides have been shown to be effective in the treatment of pharyngitis caused by GABHS, but their superiority to penicillin has not been clearly established. Compared with penicillin, these agents have a much broader spectrum of antimicrobial activity and are considerably more expensive; thus, they cannot be recommended for routine use for this infection. For patients who are having multiple episodes of pharyngitis associated with positive throat cultures (for GABHS) or rapid antigen detection tests, the physician must distinguish between those who are streptococcal carriers and those who are having recurrent acute episodes of streptococcal pharyngitis.