https://pubmed.ncbi.nlm.nih.gov/38648833/

Group A beta-hemolytic streptococcal (GABHS) pharyngitis causes over 6 million office visits annually in the U.S., though only 10% of adults with sore throat actually have it. Despite this, over 60% receive antibiotics. Guidelines advise using clinical decision rules and rapid antigen testing before prescribing antibiotics. Key signs include fever, tonsillar exudate, cervical lymphadenitis, and age 3–15, while a cough suggests a viral cause. Virtual assessments can effectively apply these rules. If a rapid test is negative in children, a throat culture is advised. First-line treatment includes penicillin or amoxicillin for 10 days; cephalosporins for those with non-severe penicillin allergies. Resistance to azithromycin and clarithromycin is rising. Steroids are not recommended. Patients not improving after antibiotics should be reevaluated. Tonsillectomy is rarely needed and only considered with recurrent infections over multiple years.