Acute Pharyngitis in Adults: Physician Information Sheet (Adults)
Principles apply to the diagnosis and treatment of Group A ß-hemolytic streptococcal (GABHS) pharyngitis in otherwise healthy adults.
Clinical screening for GABHS pharyngitis could substantially reduce unnecessary antibiotic use.
- Only 5-15% of adult cases of acute pharyngitis are caused by GABHS.
- It is estimated that 3,000 to 4,000 patients with GABHS must be treated for every 1 case of acute rheumatic fever prevented.
- Antibiotic therapy of GABHS hastens resolution by 1-2 days if initiated within 2-3 days of symptom onset.
- Lab testing is not indicated in all patients with pharyngitis. Instead, all adults should be screened for the following:
- History of fever
- Lack of cough
- Tonsillar exudates
- Tender anterior cervical adenopathy
- Patients with none or only one of these findings should not be tested or treated for GABHS.
- Rapid streptococcal antigen test (RAT) is recommended for patients with 2 or more criteria, with antibiotic therapy restricted to those with positive test results.
- Cultures are not recommended for routine evaluation of adult pharyngitis or for confirmation of negative results on rapid antigen tests if test sensitivity >80%.
- Throat cultures maybe useful for outbreak investigation, monitoring rates of antibiotic resistance, or when other pathogens (e.g., gonococcus) are being considered.
Comparison of Diagnostic Strategies*
|Test for 2+
|Empiric treatment for 3-4 criteria|
|% of patients
with GABHS who are correctly
|% of patients
sensitivity = 80%;
RAT specificity = 90%;
GABHS prevalence = 10%.
- Penicillin is recommended for initial treatment of GABHS.
- Erythromycin is recommended for penicillin-allergic patients.
- Penicillin-resistant GABHS have not been reported in the United States.
- Extended spectrum macrolides and fluoroquinolones are not appropriate for uncomplicated GABHS pharyngitis.
Tips to Reduce Antibiotic Use
- Tell patients that antibiotic use increases the risk of an antibioticresistant infection.
- Identify and validate patient concerns.
- Recommend specific symptomatic therapy.
- Spend time answering questions and offer a contingency plan if symptoms worsen.
- Provide patient education materials on antibiotic resistance.
- REMEMBER: Effective communication is more important than an antibiotic for patient satisfaction.
- See www.cdc.gov/drugresistance/community or contact your local health department for more information and patient education materials.
Cooper RJ et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Medicine 2001;134(6):509-17.
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