Scope of this summary
Children aged three years or older and adults with acute pharyngeal symptoms. The 2025 IDSA update covers clinical scoring to decide who should be tested; it is Part 1 of a multi-part update, so treatment statements here remain separately attributed to current CDC outpatient guidance. Infants, immunocompromised patients and airway emergencies need tailored care.
The Bottom Line
- Most acute sore throats are viral. Use a validated clinical scoring system to identify low-probability patients who are unlikely to benefit from group A streptococcal testing rather than testing every presentation.
- Consider testing despite a low score when risk is unusually high, including household GAS exposure, previous rheumatic fever or signs of scarlet fever, deep-space infection or streptococcal toxic shock.
- Do not diagnose GAS from symptoms alone when testing is indicated; in adults, treat a confirmed infection and do not prescribe an antibiotic after a negative rapid antigen detection result.
- Penicillin or amoxicillin remains first-line CDC treatment for confirmed GAS when appropriate; verify allergy phenotype and use local resistance information for non-beta-lactam alternatives.
Practical clinical workflow
1
Assess duration, fever, cough, coryza, conjunctivitis, oral ulcers, rash, tender nodes, tonsillar findings, exposure, vaccination and sexual history when relevant, while checking hydration and airway stability.
2
Apply a chosen score consistently in patients aged three years or older, then combine the result with high-risk features, local epidemiology and patient context to decide whether RADT, NAAT or culture is warranted.
3
Give analgesia, hydration advice and return precautions for viral or test-negative illness; for confirmed GAS, prescribe a source-supported regimen and explain completion, adverse effects and transmission precautions.
4
Reassess worsening, persistent or recurrent illness for peritonsillar or retropharyngeal abscess, epiglottitis, Lemierre syndrome, mononucleosis, acute HIV, gonococcal infection or another non-GAS cause.
Safety boundaries and escalation
- Drooling, stridor, respiratory distress, tripod positioning, inability to swallow secretions, toxic appearance, trismus, neck swelling or a muffled voice requires urgent airway-capable assessment.
- The 2025 IDSA score recommendation does not apply to children younger than three years because typical scoring features do not perform reliably in that group.
- Do not treat a likely GAS carrier who has a viral syndrome merely because an indiscriminate test is positive; align testing with pretest probability to reduce false attribution and antibiotic harm.
- Report and manage invasive GAS, scarlet-fever clusters or public-health concerns under applicable state and local rules; outpatient pharyngitis guidance is not an invasive-infection protocol.
Localization
US practice uses IDSA 2025 risk assessment and CDC testing/treatment stewardship. IDSA Part 2 was still pending at the source-check date, so this page must be updated when that treatment component is released.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Infectious Diseases Society of America2025 Clinical Practice Guideline Update on Group A Streptococcal Pharyngitis: Risk Assessment Using Clinical Scoring Systems in Children and AdultsPart 1; literature search through March 2025 路 published 2025-10-14 路 accessed 2026-08-20view source
- Centers for Disease Control and PreventionOutpatient Clinical Care for Adults: Antibiotic Prescribing and Useupdated 2024-04-16 路 accessed 2026-08-20view source
- Centers for Disease Control and PreventionOutpatient Clinical Care for Pediatric Populations: Antibiotic Prescribing and Useupdated 2024-04-22 路 accessed 2026-08-20view source
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