An updated IDSA guideline for the diagnosis and management of group A streptococcal (GAS) pharyngitis is now available online and will appear in the Nov. 15 issue of Clinical Infectious Diseases.
The objective of the guideline, which replaces a guideline issued in 2002, is to provide recommendations for appropriate treatment and management of this common clinical condition. It addresses concerns clinicians face related to the diagnosis of streptococcal pharyngitis and its treatment in patients, including those allergic to penicillin. Specific treatment recommendations are provided, such as penicillin or amoxicillin, and include recommendations for the penicillin-allergic patient.
“The guideline promotes accurate diagnosis and treatment, particularly in avoiding the inappropriate use of antibiotics, which contributes to drug-resistant bacteria,” said lead author Stanford T. Shulman, MD, chief of the division of infectious diseases at Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of pediatrics at Northwestern University Fineberg School of Medicine. “We recommend penicillin or amoxicillin for treating strep because they are very effective and safe in those who are not allergic, and there is increasing resistance of strep to the broader-spectrum—and more expensive—macrolides, including azithromycin.”
The guideline provides key recommendations such as identifying the preferred method of diagnosis for patients with streptococcus pharyngitis. For instance, clinicians should swab the throat and test for GAS pharyngitis by rapid antigen detection test, since clinical features cannot discriminate between GAS and viral pharyngitis. In addition, several recommendations are provided regarding the preferred treatment regimen (e.g., antibiotic dosage and duration) for patients diagnosed with GAS
The guideline explains that improved methods of diagnosis are under study. Therefore, future research should focus on issues such as distinguishing acute infection from chronic pharyngeal carriage and developing simpler therapeutic regimens for acute GAS pharyngitis.
A podcast with Dr. Shulman is available on IDSA’s website, and the guideline will be available in a smartphone format and a pocket-sized quick-reference edition. Visit the practice guidelines section of the IDSA website for additional guidelines and related resources.
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