Diagnosis

Treatment

Document Overview

Design and created by Guideline Central in participation with the Infectious Diseases Society of America.

Diagnosis and Management of Group A Streptococcal Pharyngitis

Infectious Diseases Society of America

Publication Date: Sep 9, 2012

Page Last Updated: May 5, 2026

Grading Table

Category/Grade	Definition
Recommendation
SR - Strong	Clear desirable or undesirable effects
WR - Weak	Desirable and undesirable effects closely balanced or uncertain
Quality of Evidence
H - High	Consistent evidence from well-performed RCTs or exceptionally strong evidence from unbiased observational studies
M - Moderate	Evidence from RCTs with important limitations or moderately strong evidence from unbiased observational studies
L - Low	Evidence for ≥1 critical outcome from observational studies, from RCTs with serious flaws or from indirect evidence
VL - Very Low	Evidence for ≥1 critical outcome from unsystematic clinical observations or very indirect evidence
GRADE	Implication	Comment
SR-H	Applies to most patients in most circumstances	Further research is unlikely to change estimate
SR-M		Further research may change estimate
SR-L
SR-VL	Estimate of effect for at least one critical outcome is very uncertain
WR-H	The best action may differ depending on circumstances or patients or societal values	Further research is unlikely to change estimate
WR-M	Alternative approaches likely to be better for some patients under some circumstances	Further research may change estimate
WR-L	Other alternatives may be equally reasonable	Further research may change estimate
WR-VL	Other alternatives may be equally reasonable	Any estimate of effect, for at least one critical outcome, is very uncertain

For the complete GRADE Strength of Recommendations and Quality of the Evidence Table, visit the IDSA website: http://www.idsociety.org/Guidelines_Other/

Document Overview

Document Title: Diagnosis and Management of Group A Streptococcal Pharyngitis

Authoring Society: Infectious Diseases Society of America

Document Publication Date: Sep 9, 2012

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: academic.oup.com/cid/article/55/10/e86/321183?searchresult=1

Source Citation: Clinical Practice Guidelines for the Diagnosis and Management Of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C.

Supplemental Implementation Resources

Quick-Reference Guide

Document Scope, Criteria, and Use Cases

Document Objectives: Group A streptococcal (GAS) pharyngitis is a significant cause of community-associated infections. This document constitutes a revision of the 2002 guideline of the Infectious Diseases Society of America (IDSA) on the treatment of GAS pharyngitis. The primary objective of this guideline is to provide recommendations on the management of this very common clinical condition among adult and pediatric patients. The guideline addresses issues related to the diagnosis of streptococcal pharyngitis and its treatment in patients who are or are not allergic to penicillin. The guideline does not discuss active surveillance testing or other prevention strategies. Each section of the guideline begins with a specific clinical question and is followed by numbered recommendations and a summary of the most-relevant evidence in support of the recommendations. Areas of controversy in which data are limited or conflicting and in which additional research is needed are indicated throughout the document and are highlighted in the Future Research section.

Scope: Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D010612 - Pharyngitis

D013290 - Streptococcal Infections

D010612 - Pharyngitis

D013290 - Streptococcal Infections

Keywords: pharyngitis, pharyngotonsillitis, sore throat, streptococcal

Target Patient Population: adult and pediatric patients with group A streptococcal (GAS)

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Infant, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

How should the diagnosis of GAS pharyngitis be established?
Who should undergo testing for GAS pharyngitis?
What are the treatment recommendations for patients with a diagnosis of GAS pharyngitis?
Should adjunctive therapy with NSAIDs, acetaminophen, aspirin, or corticosteroids be given to patients with a diagnosis of GAS pharyngitis?
Is the patient with frequent recurrent episodes of apparent GAS pharyngitis likely to be a chronic pharyngeal carrier of GAS?

Number of Source Documents: 134

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Diagnosis and Management of Group A Streptococcal Pharyngitis

Diagnosis

Treatment

Table 3. Antibiotic Regimens Recommended for Group A Streptococcal Pharyngitis

Table 4. Treatment Regimens for Chronic GAS Carriers

Grading Table

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology