Managing streptococcal pharyngitis: a review of clinical decision-managing strategies, diagnostic evaluation, and treatment.

Prompt and accurate diagnosis of GABHS pharyngitis is critical to prevent ARF, tonsillar abscess, toxic-shock-like syndrome, bacteremia, and deep tissue cellulitis which can result in significant morbidity and death. Antibiotic treatment of all patients that have complaints of sore throat incurs unnecessary costs and potential drug resistance. On the other hand, culturing all patients with complaints of sore throat incurs unnecessary costs and false positive cultures in patients. Utilizing a sensitive and specific clinical guideline assists clinicians in deciding who to culture or screen, and who to reassure and educate about their underlying non-GABHS illness. Also, clinicians need to know the sensitivity and specificity of the diagnostic tests used and each tests' limitations. While small numbers of patients fail treatment with penicillin, it remains the drug of choice for the treatment of GABHS and prevention of ARF, and its effectiveness at eradicating GABHS in the pharynx is superior.