Management of Pharyngitis in Children

Diagnosis and Treatment

The Infectious Diseases Society of America (IDSA) recommends that antimicrobial therapy should be prescribed only for proven episodes of GAS pharyngitis, particularly given the general increase in rates of antibiotic resistance 1
A negative GAS throat swab result allows the clinician to safely avoid the use of antibiotics, as the vast majority of children with acute pharyngitis have a viral etiology and do not need antibiotic treatment 1
Only 20-30% of children with pharyngitis actually have GAS infection, and up to 70% of patients with sore throats inappropriately receive antimicrobial prescriptions 1, 2, 3
The American Heart Association confirms that treatment is only effective at preventing rheumatic fever when GAS infection is actually present, and even delayed treatment 24-48 hours to process throat culture carries no increased risk of rheumatic fever 5, 6

Stopping unnecessary antibiotics provides several benefits, including avoiding adverse effects such as rash, diarrhea, and rarely anaphylaxis, reducing selection pressure for antibiotic-resistant organisms, and avoiding unnecessary broader-spectrum antimicrobial exposure 7, 8, 9, 1
The child's symptoms will resolve spontaneously if viral in origin, typically within a few days, and symptomatic management with analgesic/antipyretic agents such as acetaminophen and reassurance can be provided 10, 7

Negative rapid antigen detection tests (RADTs) in children should be confirmed with throat culture because RADTs have sensitivities of only 70-90% in pediatric populations 2, 4
A negative GAS throat swab result, whether from RADT or culture, provides reassurance that the patient likely has a viral cause of pharyngitis, and if both RADT and backup culture are negative, antibiotics are definitively not indicated 2, 4