NMA: Nonprescription Medicines Academy

Updated Clinical Practice Guideline Urges Antimicrobial Therapy Only for Confirmed Cases of Streptococcal Pharyngitis

October 17th, 2012

A 2012 revision of the 2002 Infectious Diseases Society of America (IDSA) guideline on diagnosis and management of Group A streptococcal (GAS) pharyngitis (“strep throat”) in adult and pediatric patients urges physicians to refrain from prescribing antimicrobial agents for pharyngitis unless the results of rapid antigen detection testing confirm the presence of group A streptococcus. Penicillin or amoxicillin remain the antimicrobial agents of choice; penicillin-allergic patients may be treated with a first-generation cephalosporin, clindamycin, clarithromycin, or azithromycin.

According to the IDSA, approximately 15 million Americans consult a physician each year with a chief complaint of sore throat. As many as 70% of patients are treated with antimicrobial agents, despite the fact that only 20%–30% of children and 5%–15% of adults have GAS pharyngitis. Inappropriate antimicrobial therapy for upper respiratory tract infections has been a major contributor to the development of antimicrobial resistance.

The updated guideline addresses the following five clinical questions:

1. How should the diagnosis of GAS pharyngitis be established?
2. Who should undergo testing for GAS pharyngitis?
3. What are the treatment recommendations for patients with a diagnosis of GAS pharyngitis?
4. Should adjunctive therapy with NSAIDs, acetaminophen, aspirin, or corticosteroids be given to patients with a diagnosis of GAS pharyngitis?
5. Is the patient with frequent recurrent episodes of apparent GAS pharyngitis likely to be a chronic pharyngeal carrier of GAS?

The complete text is available online at http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full.

Clin Infect Dis. 2012 Sep 9. [Epub ahead of print]