Group A beta-hemolytic streptococcal pharyngitis continues to be a major problem and accounts for a large number of physician visits. The recent resurgence of acute rheumatic fever in several areas in the United States underlines the need to accurately diagnose and correctly treat streptococcal pharyngitis. Appropriate treatment with antibiotics effectively prevents rheumatic fever. Early institution of treatment also leads to prompt alleviation of symptoms. The 'gold standard' for diagnosing group A streptococcal pharyngitis is the throat culture. Newer rapid diagnostic tests may be used, but the clinician must recognize that there are a substantial number of false-negative tests (low sensitivity). Therefore, patients with negative rapid tests should have standard throat cultures as well. Patients with positive rapid tests should be treated with appropriate antibiotics, as should patients with positive throat cultures. Patients with signs and symptoms that are highly suggestive of streptococcal pharyngitis can also be treated, pending throat culture results. Penicillin continues to be the drug of choice for treatment, and American Heart Association guidelines suggest the use of oral penicillin V for ten days or intramuscular benzathine penicillin G. Alternative antibiotics commonly used include erythromycin and various cephalosporins. Throat cultures need not be obtained from most patients after therapy. However, some patients may seem to be having frequent streptococcal infections or may be recognized as asymptomatic carriers. Carriers may be considered for therapy with intramuscular benzathine penicillin G plus oral rifampin.
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