Treatment of Acute Pharyngitis with Positive Rapid Strep A Test (GABHS Infection)
This protocol covers acute pharyngitis caused by group A beta-haemolytic streptococcus (GABHS), identified by a positive rapid antigen detection (Strep A) test, in patients who have no allergy to penicillin or beta-lactam antibiotics.
Clinical Scenario
Among patients presenting with acute pharyngitis, identifying GABHS infection is the key step that triggers antibiotic treatment. A positive rapid Strep A test confirms the bacterial aetiology and distinguishes these cases from viral pharyngitis. GABHS has remained sensitive to penicillin-class antibiotics globally, making antibiotic therapy both appropriate and effective in this setting.
Treatment Approach
First-line management involves a course of beta-lactam antibiotic therapy. Both oral and single-dose injectable options exist within this class. The complete regimen — including the specific agents, their sequencing, and any alternatives for special circumstances — is detailed in the structured protocol.
References
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.
- In the event of intolerance to the treatment of choice, amoxicillin 500 mg/12 h can be given.
- A first-generation cephalosporin can also be administered, such as cefadroxil 500 mg/12 h.
- Penicillin G 1.2 M I.U. i.m. 1 dose
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