Update on the Management of Streptococcal Pharyngitis

Elias B. Chahine, PharmD, BCPS (AQ-ID); John Chamoun, PharmD Candidate; Allana J. Sucher, PharmD, BCPS


US Pharmacist. 2013;38(7):51-56. 

In This Article

Abstract and Introduction


Acute pharyngitis is a common infection that is typically managed in the outpatient setting. While respiratory viruses are responsible for the majority of cases, group A streptococcus (GAS) is the most common bacterial cause of what is generally referred to as strep throat. The Infectious Diseases Society of America recently released updated clinical practice guidelines for the diagnosis and management of GAS pharyngitis. First-line treatment for GAS pharyngitis is penicillin or amoxicillin, and alternative agents include a first-generation cephalosporin, clindamycin, clarithromycin, and azithromycin. Pharmacists are in a key position to improve outcomes for patients with acute pharyngitis through recommendations for appropriate antimicrobial therapy, monitoring of adverse effects, and prevention of drug interactions.


Acute pharyngitis is one of the most common childhood diseases throughout the world, with more than 7 million outpatient office visits each year.[1] In the United States, approximately 20% to 30% of cases of acute pharyngitis in children and 5% to 15% of cases in adults are due to group A streptococcus (GAS).[1–3] According to the 2010 National Hospital Ambulatory Care Survey, acute pharyngitis is ranked among the top 20 most-reported diagnoses for outpatient emergency department visits, resulting in an economic burden to society ranging from $224 to $539 million per year.[4,5]

While many patients presenting with sore throat have an underlying infection, fewer than 20% have a clear indication for antibiotic therapy.[6] It is important to discern which patients require antibiotic therapy to avoid unnecessary use of antibiotics. The Infectious Diseases Society of America (IDSA) released updated clinical practice guidelines for the diagnosis and management of GAS pharyngitis in November 2012.[3] The purpose of this review is to educate pharmacists on the proper management of adult and pediatric patients presenting with pharyngitis according to the IDSA guidelines.