What are the IDSA diagnostic guidelines for tonsillitis and peritonsillar abscess (PTA)?

Updated: Apr 06, 2020
  • Author: Udayan K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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In 2012, the Infectious Diseases Society of America (IDSA) released updated guidelines for the diagnosis and management of group A streptococcal (GAS) pharyngitis. Recommendations for diagnosis and testing are summarized as follows [17] :

  • Testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture should be performed to distinguish between GAS and viral pharyngitis
  • In children and adolescents, negative RADT results should be backed up by a throat culture; positive results are highly specific and do not require a backup culture
  • In adults, routine use of backup throat cultures for those with a negative RADT is not necessary because the risk of subsequent acute rheumatic fever is low in adults with acute pharyngitis
  • Anti-streptococcal antibody titers are not recommended in the routine diagnosis of acute pharyngitis
  • In general, testing for GAS pharyngitis is not recommended for children or adults with a clinical presentation that strongly suggests a viral etiology (eg, cough, rhinorrhea, hoarseness, oral ulcers)
  • Acute rheumatic fever is rare in children under age 3 years, and the incidence and classic presentation of streptococcal pharyngitis are uncommon in this age group; thus, testing for GAS pharyngitis is not indicated for children under age 3 years; however, children under age 3 years who have other risk factors, such as an older sibling with GAS infection, may be considered for testing
  • Diagnostic testing or treatment of asymptomatic close contacts of patients with acute streptococcal pharyngitis is not routinely recommended

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