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Group A streptococcal pharyngitis in children
Most sore throats in children are viral; antibiotics are given only after laboratory proof of Streptococcus pyogenes, and the main goal is preventing rheumatic fever.
Why it matters in the exam
The question describes a school-age child with fever, sore throat, tonsillar exudate and tender neck nodes, without cough or rhinorrhoea, and asks for the next step. The answer is a rapid antigen detection test (RADT) or a culture — not treatment based on appearance alone. When there is cough, rhinorrhoea, hoarseness, conjunctivitis or oral ulcers, the cause is almost always viral and no test is needed at all.
In children and adolescents a negative rapid test needs a confirmatory culture, because its sensitivity is not sufficient and rheumatic fever can be serious; a positive rapid test needs no culture. Children under 3 are usually not tested, because rheumatic fever is very rare at that age, and asymptomatic household contacts are not tested, nor is a test of cure done after treatment.
Treatment is penicillin V or amoxicillin for 10 days, or a single injection of benzathine penicillin G. Treatment started within 9 days of onset prevents rheumatic fever but does not prevent post-streptococcal glomerulonephritis. Amoxicillin given to a child with infectious mononucleosis causes a rash — a recurring distractor. Local complications such as peritonsillar abscess (trismus, a "hot potato" voice, deviated uvula) and retropharyngeal abscess in a young child are also examined.
Key points
- A sore throat with cough and rhinorrhoea is viral — do not test.
- A negative RADT in a child → confirmatory culture.
- Amoxicillin or penicillin for 10 days, or a single dose of benzathine penicillin G.
- The central goal is preventing rheumatic fever; treatment up to 9 days after onset still protects.
- Children under 3 are usually not tested for GAS.
Summary table
| Situation | Pointing finding | Step | Treatment |
|---|---|---|---|
| Suspected GAS (age 3 and over) | Fever, tonsillar exudate, tender anterior cervical nodes, no cough | RADT; if negative in a child → culture | Amoxicillin 50 mg/kg once daily (max 1000 mg) for 10 days |
| Viral picture | Cough, rhinorrhoea, hoarseness, conjunctivitis, ulcers | No testing | Supportive care |
| Scarlet fever | Sandpaper rash, strawberry tongue, Pastia lines | RADT or culture | As for GAS |
| Penicillin allergy | Non-anaphylactic versus anaphylactic | By type of reaction | Cephalexin for 10 days; otherwise clindamycin for 10 days or azithromycin for 5 days |
| Peritonsillar abscess | Trismus, deviated uvula, muffled voice | Clinical examination, imaging if needed | Drainage and antibiotics |
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Sources
- IDSA Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis, 2012 update — Diagnosis and treatment recommendations
- AAP Red Book: Report of the Committee on Infectious Diseases, 2024–2027 — Group A Streptococcal Infections
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Acute Pharyngitis
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.