This protocol applies when acute pharyngitis is caused by group A beta-haemolytic streptococcus (GABHS), confirmed by a positive rapid antigen detection (Strep A) test, in a patient with no allergy to penicillin or beta-lactam antibiotics.
A positive Strep A rapid antigen test establishes GABHS as the causative pathogen. Identifying GABHS infection is the critical first step, as these cases require antibiotic treatment — unlike viral pharyngitis. The absence of penicillin allergy determines which first-line agent applies.
When Strep A positivity is confirmed in a patient tolerant of penicillin, phenoxymethyl penicillin (Penicillin V) is the recommended antibiotic — GABHS has remained globally sensitive to this agent. The complete regimen, including the required treatment duration, is detailed in the full protocol.
DOI: 10.1016/j.otoeng.2015.05.003
Given the evidence which is currently available, the primary care physician should first identify GABHS infection, as these cases need to be treated with antibiotics.
In the case of Strep A positivity, the use of phenoxymethyl penicillin or penicillin V is recommended (1 200 000 I.U./12 h orally), as GABHS has been and remains sensitive to this antibiotic globally.
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