Management of Group A beta-hemolytic streptococcal pharyngitis

Bacteria are responsible for approximately 5 to 10 percent of pharyngitis cases, with group A beta-hemolytic streptococci being the most common bacterial etiology. A positive rapid antigen detection test may be considered definitive evidence for treatment; a negative test should be followed by a confirmatory throat culture when streptococcal pharyngitis is strongly suspected. Treatment goals include prevention of suppurative and nonsuppurative complications, abatement of clinical signs and symptoms, reduction of bacterial transmission and minimization of antimicrobial adverse effects. Antibiotic selection requires consideration of patients' allergies, bacteriologic and clinical efficacy, frequency of administration, duration of therapy, potential side effects, compliance and cost. Oral penicillin remains the drug of choice in most clinical situations, although the more expensive cephalosporins and, perhaps, amoxicillin-clavulanate potassium provide superior bacteriologic and clinical cure rates. Alternative treatments must be used in patients with penicillin allergy, compliance issues or penicillin treatment failure. Patients who do not respond to initial treatment should be given an antimicrobial that is not inactivated by penicillinase-producing organisms (e.g., amoxicillin-clavulanate potassium, a cephalosporin or a macrolide). Patient education may help to reduce recurrence.