Group A strep pharyngitis
What the major U.S. guidelines recommend, with a link to verify each at the source. A quick-reference summary for clinicians, not medical advice.
Testing update (Part 1, Oct 2025): use a clinical scoring system (Centor or McIsaac) to decide who to test in children 3+ and adults (conditional, very low certainty). Scoring best identifies low-risk patients in whom testing is unlikely to help. Low risk (Centor/McIsaac 0 to 1, ~7 to 13% GAS): testing usually not needed. Higher score: test by RADT or culture. Does not apply to children under 3; still test high-risk patients (household exposure, prior rheumatic fever) regardless of score.
Verify at IDSA →Penicillin V or amoxicillin first line x10d. Pen V 250 mg BID to TID (kids), 250 mg QID or 500 mg BID (adults). Amox 50 mg/kg once daily (max 1000 mg). Benzathine pen G IM single: 600,000 U if <27 kg, 1,200,000 U if >=27 kg. Pen allergy: cephalexin, clindamycin, or clarithromycin x10d, or azithromycin x5d. Confirm RADT or culture before treating; back up negative RADT with culture in children, not adults.
Verify at IDSA →Do not test patients with clear viral features. Confirm with RADT or culture; in children 3+, back up a negative RADT with throat culture (gold standard). First line: penicillin or amoxicillin x10d. Avoid cephalexin and cefadroxil in immediate-type penicillin hypersensitivity.
Verify at CDC →