Patient Population: Adult
Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration

Viral (EBV, rhinovirus, coronavirus, adenovirus etc)

Group A Streptococcus (5-20%)

Less common:

Group C and G Strep

Arcanobacterium haemolyticum

Fusobacterium necrophorum

Also consider sexually transmitted infections
Penicillin VK 500 mg PO BID Clindamycin 300 mg PO TID

Most pharyngitis is viral thus antibiotics should not be used.

Treat documented Group A streptococcal infection confirmed by rapid strep. antigen test or culture or if at least 3 out 4 clinical criteria present:

Clinical Criteria: history of fever, tender anterior cervical adenopathy, absence of cough, tonsillar exudates.

Penicillin resistance has not been observed

10 days
Clinical Infectious Diseases, Volume 55, Issue 10, 15 November 2012, Pages e86–e102,