Fall 2025 Newsletter: Streptococcal Pharyngitis AAP Antibiotics Stewardship Guidelines
Group A Streptococcal
- Sudden onset of sore throat
- Age 5–15 years
- Fever
- Headache
- Nausea, vomiting, abdominal pain
- Tonsillopharyngeal inflammation
- Patchy tonsillopharyngeal exudates
- Palatal petechiae
- Anterior cervical adenitis (tender nodes)
- History of exposure to strep pharyngitis
- Scarlatiniform rash
Viral Illness
- Conjunctivitis
- Coryza
- Cough
- Diarrhea
- Hoarseness
- Ulcerative lesions
- Viral exanthema
Diagnosis
- Streptococcal testing is recommended by the IDSA to confirm the diagnosis of streptococcal pharyngitis
- Rapid Antigen Test (67-93% sensitive, 98% specificity)
- Must obtain a back-up culture in all negatives
- Rapid PCR Test (98% sensitivity/specificity)
- Back up culture not needed
- PCR can remain positive for up to 2 months
- Wait at least 2 weeks after completion of treatment before considering repeat PCR. Consider sending a throat culture instead of using PCR for repeat testing
- Clinical scoring systems are not specific in children and should not be used to make the diagnosis (McIsaac, Centor, etc)- 35-50% accuracy
- Do NOT test or treat the following:
- Children < age 3: group A Streptococcus is an uncommon etiology, and sequelae are rare in patients <3 years old. Testing and treatment may be considered for some symptomatic children younger than 3 years who have an older sibling with GAS infection (Red Book: 2024–2027 Report of the Committee on Infectious Diseases (33rd Edition)
- Children with ≥ 1 viral symptom (cough, rhinorrhea)
- Asymptomatic children (sick contact, etc.)
Consider implementing automatic swabbing protocol if patients meet the following criteria:
- ≥ 3 years old with a sore throat AND At least 1 of the following:
- Absence of cough and other viral symptoms
- Tender anterior cervical lymph node
- Tonsillar exudate or swelling
- Fever/reported fever > 38 C
- Do not swab if cough, rhinorrhea, hoarse voice or oral ulcers
Treatment:
