-
GAS suspected, acute episode, awaiting dx
Test according to age: - If <3 yo: Testing not recommended1,2
- If 3-18 yo: Perform RADT; if negative, perform TC2-4
- If >18 yo: Perform RADT; back-up TC not required if negative3,5
Other diagnostic considerations: - Test pts w/ sx suggestive of GAS pharyngitis (eg, persistent fever, anterior cervical adenitis, tonsillopharyngeal exudates) by RADT and/or TC6
- Testing for GAS not recommended in children/adults w/ features suggestive of viral etiology2,7,8
- Do not order antistreptococcal Ab titers for routine GAS dx, as they reflect past, but not current, events9
- Testing/empiric tx of asymptomatic household contacts not routinely recommended,10 unless index pt has ARF11
Footnotes 1 IDSA 2012 [S] [M]. Testing not recommended: ARF rare, GAS pharyngitis uncommon. Consider testing if s/sx of GAS pharyngitis and older sibling w/ GAS infxn: perform RADT; if negative, perform TC. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
2 AAP 2021-2024. Testing not recommended in pts w/ evidence of viral infxn (eg, rhinorrhea, cough, hoarseness, oral ulcers).
Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021. Accessed online 6/13/23
3 AHA 2009 [IIa] [C]. Double-check negative RADTs w/ blood agar plate cultures if <18. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
4 IDSA 2012 [S] [H]. Back-up negative RADT test w/ TC if <18 yo. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
5 IDSA 2012. OK to r/o out GAS pharyngitis dx based on negative RADT: low GAS pharyngitis and ARF/carditis risk in adults; although risk of GAS pharyngitis higher w/ occupational/parental contact w/ school-aged children. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
6 ACP/CDC 2016. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
7 IDSA 2012 [S] [H]. Sx suggestive of viral pharyngitis: cough, rhinorrhea, hoarseness, oral ulcers. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
8 AHA 2009 [IIb] [B]. In pts w/ acute pharyngitis and findings suggestive of viral origin, pretest probability of GAS is low, and testing usually not needed. The following sx are highly suggestive of a viral cause for pharyngitis: coryza, hoarseness, cough, diarrhea, conjunctivitis, viral enanthem/exanthem. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/19
9 IDSA 2012 [S] [H]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
10 IDSA 2012 [S] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
11 AHA 2009. Although testing asymptomatic household contacts
of children w/ GAS pharyngitis not routinely recommended, obtain throat swab specimens from all household contacts of a child w/ ARF; if test results positive, that contact should be treated. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
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GAS confirmed, acute episode (initial/repeat), awaiting tx
Treat initial/repeat acute episode w/ PO penicillin/amoxicillin or IM benzathine penicillin G; consider adjunctive tx - PCN VK: Adolescents/adults: 250 mg PO qid or 500 mg PO bid x10 days.1-3 AHA4 recommends 500 mg PO bid-tid for adults/adolescents or children >27 kg. Children (≤27 kg):4 250 mg PO bid-tid x10 days1,3,4
- amoxicillin: 50 mg/kg PO daily x10 days; max: 1,000 mg/day;1-4 alternate: 25 mg/kg PO bid x10 days; max: 500 mg/dose1-3
- PCN G benzathine: <27 kg: 600,000 units IM x1;1,3,4 ≥27 kg: 1.2 million units IM x11-4
- Adjunctive tx: Consider analgesics/antipyretic if high fever, mod/severe sx,1 but avoid aspirin in children.5 Corticosteroids not recommended6
If repeated/recurrent episodes, consider possibility of chronic carrier state - A pt w/ >1 episode of bona fide GAS pharyngitis at close intervals may actually be a chronic pharyngeal GAS carrier who is experiencing repeated viral infxns5
- Efforts to identify/treat GAS carriers not ordinarily justified;7,8 however, since it is impossible to distinguish carriers who are experiencing an intercurrent viral infxn from GAS-infected individuals, a single course of abx is appropriate for pts w/ acute pharyngitis who test positive for GAS9
- Do not perform tonsillectomy solely to reduce frequency of GAS pharyngitis1
Footnotes 1 IDSA 2012 [S] [H]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
2 ACP/CDC 2016. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
3 CDC 2022. Group A Streptococcal (GAS) Disease. Pharyngitis (Strep Throat). Content source: National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Page last reviewed: 6/27/22. Accessed online 6/12/23
9
4 AHA 2009 [I] [B]. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
5 IDSA 2012 [S] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
6 IDSA 2012 [W] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
7 IDSA 2012 [S] [M]. Efforts to identify carriers not normally justified nor is abx tx required, as GAS carriers unlikely to spread GAS to close contacts and are at little/no risk for developing suppurative/nonsuppurative complications
(eg, ARF). Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
8 ACP/CDC 2016. Abx not recommended for chronic GAS carriers as they are unlikely to spread infxn to close contacts and are at little/no risk for
complications. Tonsillectomy solely to reduce frequency of GAS pharyngitis in adults is not recommended. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
9 AHA 2009 [I] [C]. Chronic carriers (defined as individuals w/ (+) GAS on throat cx w/o clinical findings or immunologic response to GAS antigens) usually do not need to be identified or treated w/ abx. Carriage may persist for many mo; diagnostic dilemma arises when symptomatic upper resp tract viral infxns develop in carriers. Impossible to distinguish carriers from infected individuals, so a single course of appropriate abx should be administered to any pt w/ acute pharyngitis and evidence of GAS by a throat cx or RADT. There is little risk for development of rheumatic fever in carriers, and risk of spreading GAS to contacts is negligible. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
PCN-allergic, non–type 1 hypersensitivity Treat initial/repeat acute episode w/ 1st-gen cephalosporin, clindamycin, azithromycin, or clarithromycin;1-3 consider adjunctive tx - cephalexin: 20 mg/kg PO bid x10 days; max: 500 mg/dose2-5
- cefadroxil: 30 mg/kg PO daily x10 days; max: 1,000 mg2-5
- clindamycin: 7 mg/kg PO tid x10 days; max: 300 mg/dose.1,3 Note: AHA6 recommends 20 mg/kg/day divided tid (max: 1.8 g/day)
- azithromycin: 12 mg/kg (max: 500 mg) PO daily x1 day, then 6 mg/kg (max: 250 mg) PO daily x4 days.1,7 Note: AHA6 recommends 12 mg/kg PO daily (max: 500 mg) x5 days
- clarithromycin: 7.5 mg/kg PO bid x10 days; max: 250 mg/dose1,6,7
- Adjunctive tx: Consider analgesics/antipyretic if high fever, mod/severe sx,5 but avoid aspirin in children.1 Corticosteroids not recommended8
If repeated/recurrent episodes, consider possibility of chronic carrier state - A pt w/ >1 episode of bona fide GAS pharyngitis at close intervals may actually be a chronic pharyngeal GAS carrier who is experiencing repeated viral infxns1
- Efforts to identify/treat GAS carriers not ordinarily justified;9,10 however, since it is impossible to distinguish carriers who are experiencing an intercurrent viral infxn from GAS-infected individuals, a single course of abx is appropriate for pts w/ acute pharyngitis who test positive for GAS11
- Do not perform tonsillectomy solely to reduce frequency of GAS pharyngitis5,10
Footnotes 1 IDSA 2012 [S] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
epocrates Note: In Table 2, the recommended dose/dosage for azithromycin should read: 12mg/kg once (max. 500 mg); then 6mg/kg (maximum = 250 mg) once daily for the next 4 days [not 12 mg/kg once (max. 500 mg) for 5 days].
Refer to erratum in Shulman ST, et al. Clin Infect Dis. 2014. May;58(10):1496. Accessed online 12/17/20
2 AHA 2009 [I] [B]. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
3 CDC 2022. Group A Streptococcal (GAS) Disease. Pharyngitis (Strep Throat). Content source: National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Page last reviewed: 6/27/22. Accessed online 6/12/23
4 ACP/CDC 2016. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
5 IDSA 2012 [S] [H]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
6 AHA 2009 [IIa] [B]. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
7 CDC 2022. GAS resistance to azithromycin and clarithromycin is well-known and varies geographically and temporally.
Group A Streptococcal (GAS) Disease. Pharyngitis (Strep Throat). Content source: National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Page last reviewed: 6/27/22. Accessed online 6/12/23
8 IDSA 2012 [W] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
9 IDSA 2012 [S] [M]. Efforts to identify carriers not normally justified nor is abx tx required, as GAS carriers unlikely to spread GAS to close contacts and are at little/no risk for developing suppurative/nonsuppurative complications
(eg, ARF). Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
10 ACP/CDC 2016. Abx not recommended for chronic GAS carriers as they are unlikely to spread infxn to close contacts and are at little/no risk for
complications. Tonsillectomy solely to reduce frequency of GAS pharyngitis in adults is not recommended. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
11 AHA 2009 [I] [C]. Chronic carriers (defined as individuals w/ (+) GAS on throat cx w/o clinical findings or immunologic response to GAS antigens) usually do not need to be identified or treated w/ abx. Carriage may persist for many months; diagnostic dilemma arises when symptomatic upper resp tract viral infxns develop in carriers. Impossible to distinguish carriers from infected individuals, so a single course of appropriate abx should be administered to any pt w/ acute pharyngitis and evidence of GAS by a throat cx or RADT. There is little risk for development of rheumatic fever in carriers, and risk of spreading GAS to contacts is negligible. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
PCN-allergic, type 1 hypersensitivity Treat initial/repeat acute episode w/ clindamycin, azithromycin, or clarithromycin;1-4 consider adjunctive tx - clindamycin: 7 mg/kg PO tid x10 days; max: 300 mg/dose;1,3,4 however, AHA2 recommends 20 mg/kg/day PO divided tid (max: 1.8 g/day)
- azithromycin: 12 mg/kg (max: 500 mg) PO daily x1 day, then 6 mg/kg (max: 250 mg) PO daily x4 days.1,5 Note: AHA2 recommends 12 mg/kg PO daily (max: 500 mg) x5 days
- clarithromycin: 7.5 mg/kg PO bid x10 days; max: 250 mg/dose1-5
- Adjunctive tx: Consider analgesics/antipyretic if high fever, mod/severe sx,6 but avoid aspirin in children.1 Corticosteroids not recommended7
If repeated/recurrent episodes, consider possibility of chronic carrier state - A pt w/ >1 episode of bona fide GAS pharyngitis at close intervals may actually be a chronic pharyngeal GAS carrier who is experiencing repeated viral infxns1
- Efforts to identify/treat GAS carriers not ordinarily justified;8,9 however, since it is impossible to distinguish carriers who are experiencing an intercurrent viral infxn from GAS-infected individuals, a single course of abx is appropriate for pts w/ acute pharyngitis who test positive for GAS10
- Do not perform tonsillectomy solely to reduce frequency of GAS pharyngitis6,9
Footnotes 1 IDSA 2012 [S] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
epocrates Note: In Table 2, the recommended dose/dosage for azithromycin should read: 12mg/kg once (max. 500 mg); then 6mg/kg (maximum = 250 mg) once daily for the next 4 days [not 12 mg/kg once (max. 500 mg) for 5 days].
Refer to erratum in Shulman ST, et al. Clin Infect Dis. 2014. May;58(10):1496. Accessed online 12/17/20
2 AHA 2009 [IIa] [B]. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
3 ACP/CDC 2016. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
4 CDC 2022. Group A Streptococcal (GAS) Disease. Pharyngitis (Strep Throat). Content source: National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Page last reviewed: 6/27/22. Accessed online 6/12/23
5 CDC 2022. GAS resistance to azithromycin and clarithromycin is well-known and is common in some communities.
Group A Streptococcal (GAS) Disease. Pharyngitis (Strep Throat). Content source: National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Page last reviewed: 6/27/22. Accessed online 6/12/23
6 IDSA 2012 [S] [H]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
7 IDSA 2012 [W] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
8 IDSA 2012 [S] [M]. Efforts to identify carriers not normally justified nor is abx tx required, as GAS carriers unlikely to spread GAS to close contacts and are at little/no risk for developing suppurative/nonsuppurative complications
(eg, ARF). Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
9 ACP/CDC 2016. Abx not recommended for chronic GAS carriers as they are unlikely to spread infxn to close contacts and are at little/no risk for
complications. Tonsillectomy solely to reduce frequency of GAS pharyngitis in adults is not recommended. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
10 AHA 2009 [I] [C]. Chronic carriers (defined as individuals w/ (+) GAS on throat cx w/o clinical findings or immunologic response to GAS antigens) usually do not need to be identified or treated w/ abx. Carriage may persist for many months; diagnostic dilemma arises when symptomatic upper resp tract viral infxns develop in carriers. Impossible to distinguish carriers from infected individuals, so a single course of appropriate abx should be administered to any pt w/ acute pharyngitis and evidence of GAS by a throat cx or RADT. There is little risk for development of rheumatic fever in carriers, and risk of spreading GAS to contacts is negligible. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
-
Chronic carrier state suspected, no acute episode
Consider possible chronic carriage:1,2 Don't treat most chronic carriers,3-6 d/t low risk of spreading dz or developing complications; tonsillectomy solely to reduce frequency of GAS pharyngitis not recommended.5,7 However, eradication of carriage may be desirable if any of the following apply:8 - Community outbreak of ARF, acute PSGN or invasive GAS infxn
- Personal/family hx of ARF
- Outbreak of GAS pharyngitis in closed/partially-closed community
- Consideration of tonsillectomy solely for carriage tx
- Significant personal/family anxiety about GAS infxns
Regimens that have demonstrated efficacy in eradication of carrier state: - clindamycin: 20-30 mg/kg/day PO divided tid x10 days; max: 300 mg/dose7
- PCN VK: 50 mg/kg/day PO divided qid x10 days; max: 2,000 mg/day; add rifampin 20 mg/kg PO daily x last 4 days of tx; max: 600 mg/day7
- amoxicillin/clavulanic acid: 40 mg amoxicillin/kg/day PO divided tid x10 days; max: 2,000 mg amoxicillin/day9
- PCN G benzathine: 600,000 units IM x1 if pt <27 kg and 1.2 million units IM x1 if ≥27 kg; add rifampin 20 mg/kg/day PO divided bid x4 days; max: 600 mg/day7
Footnotes 1 AHA 2009. Carrier defined as pt w/ positive TC for GAS w/o clinical findings or immunologic response to GAS antigens. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
2 IDSA 2012 [S] [M]. Consider chronic carrier state if pt experiences multiple acute pharyngitis episodes w/ GAS. This may represent viral infxn superimposed on chronic carrier status. Distinguish via presence of viral sx (no fever, rhinorrhea, oral ulcers, conjunctivitis, coryza, cough, diarrhea, hoarseness, oral stomatitis, or viral exanthema), clinical response to abx tx, and presence of GAS when asymptomatic. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
3 IDSA 2012. Carriers possess GAS in the pharynx w/ no clinical sx or active immunologic response to GAS antigens. No abx tx indicated: low risk of spreading dz or developing complications; routine testing not recommended [S] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
4 AHA 2009 [I] [C]. Chronic carriers usually do not need to be identified/treated w/ abx. There is little risk for development of rheumatic fever in carriers, and risk of spreading GAS to contacts is negligible. Repeated courses of abx rarely indicated in asymptomatic pts who test positive for GAS after appropriate tx. Consider 2nd course of tx in asymptomatic pts only if personal/FHx of rheumatic fever. Gerber MA, et al. Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009;119:1541-1551. Accessed online 9/28/18
5 ACP/CDC 2016. Abx not recommended for chronic GAS carriers; unlikely to spread infxn to contacts and at little/no risk for complications. Tonsillectomy solely to reduce frequency of GAS pharyngitis also not recommended. Harris AM, et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164:425-434. PubMed® abstract
6 CDC 2022. Asymptomatic GAS carriers usually do not require tx. Carriers are much less likely to transmit GAS to others and very unlikely to develop suppurative/nonsuppurative complications. Some pts w/ recurrent episodes of acute pharyngitis w/ evidence of GAS by RADT/TC actually have recurrent episodes of viral pharyngitis w/ concurrent GAS carriage. Repeated use of abx in these pts is unnecessary. However, identifying carriers clinically or by lab methods can be very difficult.
Group A Streptococcal (GAS) Disease. Pharyngitis (Strep Throat). Content source: National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. Page last reviewed: 6/27/22. Accessed online 6/12/23
7 IDSA 2012 [S] [H]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
8 IDSA 2012. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
9 IDSA 2012 [S] [M]. Shulman ST, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PubMed® abstract
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