Diagnosis and management of children with streptococcal pharyngitis

Group A streptococcal pharyngitis occurs commonly in children and is usually managed easily and effectively by practitioners. In some patients the diagnosis is confounded by lack of usual manifestations of illness, by the young age of the patient or by false negative results of a rapid diagnostic test for identifying the presence of Group A streptococci in the pharyngeal swab. Additionally the physician may be bewildered by the failure of the patient to respond adequately to what is considered appropriate antimicrobial therapy or by persistence of the organism in the pharynx for weeks to months after completion of therapy. In this communication I will discuss selected aspects of the diagnosis and management of children with Group A beta-hemolytic streptococcal pharyngitis and, where applicable, emphasize recently published information that might assist pediatricians when confronted with problem cases or perplexing laboratory data.