Group A Streptococcal (GAS) Infections Guidelines

Updated: Apr 08, 2021
  • Author: Zartash Zafar Khan, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Guidelines Summary

The Infectious Disease Society of America's key recommendations for diagnosis and treatment are outlined below. [2]


Diagnostic guidelines are as follows:

  • Rapid antigen detection test (RADT) and/or culture should be performed to distinguish between GAS and viral pharyngitis, except when overt viral features such as rhinorrhea, cough, oral ulcers, and/or hoarseness are present.
  • In children and adolescents, negative RADT results should be confirmed with a throat culture.
  • Because of the low incidence of GAS pharyngitis in adults and the exceptionally low risk of subsequent acute rheumatic fever, throat culture after a negative RADT result is unnecessary.


Treatment guidelines are as follows:

  • Penicillin or amoxicillin is the recommended drug of choice.
  • For penicillin-allergic patients, first-generation cephalosporin (for those not anaphylactically sensitive), clindamycin, clarithromycin, or azithromycin
  • As an adjunct to antibiotic therapy, acetaminophen or an NSAID should be considered for treatment of moderate to severe symptoms or control of high fever
  • Aspirin should be avoided in children
  • Corticosteroids are not recommended as adjunctive therapy  
  • Tonsillectomy solely to reduce the frequency of GAS pharyngitis is not recommended