Management of group a beta-hemolytic streptococcal pharyngitis

Bacteria are responsible for approximately 5 to 10 percent of pharyngitis c ases, with group A beta-hemolytic streptococci being the most common bacter ial etiology. A positive rapid antigen detection test may be considered def initive evidence for treatment; a negative test should be followed by a con firmatory throat culture when streptococcal pharyngitis is strongly suspect ed. Treatment goals include prevention of suppurative and nonsuppurative co mplications, abatement of clinical signs and symptoms, reduction of bacteri al transmission and minimization of antimicrobial adverse effects. Antibiot ic selection requires consideration of patients' allergies, bacteriologic a nd clinical efficacy, frequency of administration, duration of therapy, pot ential side effects, compliance and cost. Oral penicillin remains the drug of choice in most clinical situations, although the more expensive cephalos porins and, perhaps, amoxicillin-clavulanate potassium provide superior bac teriologic and clinical cure rates. Alternative treatments must be used in patients with penicillin allergy, compliance issues or penicillin treatment failure. Patients who do not respond to initial treatment should be given an antimicrobial that is not inactivated by penicillinase-producing organis ms (e.g., amoxicillin-clavulanate potassium, a cephalosporin or a macrolide ). Patient education may help to reduce recurrence.