[2013 update]

Introduction to this self-study CME activity


Pharyngitis is a common presenting complaint in primary care.  While viruses are the most common cause, group A beta hemolytic Streptococcus infection (GABHS), ABHS can be the cause in children (15%–30%) and adults (5%–10%).  The primary reason to identify and treat GABHS is to decrease the risk of acute rheumatic fever.  A growing concern is the indiscriminate use of antibiotics, which may increase the incidence of allergic reactions to antiobitics and the emergence of resistant strains of pathogenic bacteria. 

This CME activity helps clinicians estimate the probability of GABHS based on the symptoms of the patient.  The probability is used to identify a cost effective strategy for diagnosing and treating GABHS for that patient. 

 Some of the key aspects of care are:

  • Reduce the indiscriminate use of antibiotics for those who will not benefit – most sore throats are viral. 
  • Test for strep only in patients with suggestive signs and symptoms (e.g., severe sore throat, fever, tender anterior cervical lymphadenopathy, red pharynix with tonsillar swelling, no cough). 
  • If a rapid strep screen is negative:
- In patients ≥ 16 years of age, NOT sending a confirming throat culture is acceptable. 
- In patients < 16 years of age, a confirming throat culture should be sent. 
  • Recommended medications and their costs have been updated. 
- Amoxicillin as a single daily dose for 10 days is as effective as pennicillin V or amoxicillin given multiple times per day for 10 days.
- A table lists options for treating patients with symptomatic, recurrent GABHS pharyngitis.

 New information in this updated activity includes:

  • The national performance measure is now in the text:  for children 2–18 years old with a diagnosis of pharyngitis and a prescription for antibiotics, the percentage who had a strep test (screen and/or culture).
  • Amoxicillin dosing is now 50 mg/kg (1 gram maximum) once daily. 
  • If allergic to penicillin, a 10-day course of first generation cephalosporin is indicated if no history of an immediate or type I hypersensivity to penicillin.  Oral clindamycin is an acceptable alternative if one is unable to use a first generation cephalosporin. 


Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of pharyngitis in children and adults.


Participants in this CME activity will understand and be able to implement evidence-based cost-effective strategies for the diagnosis and treatment of pharyngitis in children and adults.


Team Leaders

  • Terrance P. Murphy, MD

Team Members

  • R.Van Harrison, PhD
    Medical Education
  • Annissa J. Hammoud, MD
    Internal Medicine-Pediatrics
  • Gary Yen, MD
    Family Medicine


  • Kristin C Klein, PharmD
    College of Pharmacy

Author Disclosures

Neither members of guideline team nor the consultant have relationships with commercial companies whose products are discussed in this guideline.

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant Greenberg, MD, MA, MHSA
  • R. Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was released in May 2013, with credit available through April 2016. The activity was reviewed for currency of content in April 2016 and availablility of credit extended through April 2019. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.