Diagnosing strep throat in the adult patient: Do clinical criteria really suffice?

In this issue, Neuner and colleagues report a cost-effectiveness analysis of the diagnosis and treatment of adults with pharyngitis caused by group A β-hemolytic streptococcus. Contrary to a recent American College of Physicians practice guideline, they found that treatment based on history and physical findings alone was the least effective strategy. Until controlled clinical studies measure the added value of the rapid antigen test or culture for GAS, the author does not believe it is prudent to rely exclusively on clinical criteria to diagnose and manage pharyngitis.