What are the treatment options for group A streptococcal (GAS) pharyngitis (strep throat)?

Updated: May 06, 2020
  • Author: John R Acerra, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Most cases, whether viral or bacterial, are relatively benign and self-limited. Management of GAS infection, when indicated, includes the following:

  • Do not treat patients without a positive culture or positive rapid antigen detection test result

  • Perform a rapid antigen detection test if GAS is clinically suspected on the basis of the history and physical examination; if test results are positive, begin antibiotic therapy

  • Patients with a low Centor score (0-1) can often be treated symptomatically for pharyngitis without further testing for GAS

  • Patients with a Centor score of 4 should have confirmation of GAS infection with an antigen test before being treated with antibiotics, unless such testing is unavailable

  • Household contacts of patients with GAS infection or scarlet fever should be treated for a full 10 days of antibiotics without testing only if they have symptoms consistent with GAS; asymptomatic contacts should not be treated

  • If the diagnosis is in doubt or the above criteria are not met, initiation of antibiotic therapy should await rapid antigen test or culture results

See Treatment and Medication for more detail.


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