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January 05, 2026
2 min read
Key takeaways:
- A scoring system can help determine whether a patient with a sore throat is likely to have GAS.
- The goal of the guideline is to reduce unnecessary testing and antibiotic prescriptions.
In new guidance, the Infectious Diseases Society of America suggested that clinicians use a scoring system to determine which patients should be tested for group A streptococcal pharyngitis.
The IDSA updated its guidance for the management of group A streptococcal (GAS) pharyngitis for the first time since 2012.
Providers should use a scoring system to determine which patients they should test for group A streptococcal pharyngitis, according to new guidance. Image: Adobe Stock.
“The recommendation [is] to use a clinical scoring system as part of the evaluation of patients with sore throat,” Miriam B. Barshak, MD, infectious disease specialist at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School in Boston, told Healio. “The principal utility of a scoring system is to identify patients with low probability of GAS pharyngitis in whom further evaluation by diagnostic testing is unlikely to be helpful.”
Barshak and colleagues issued the conditional guideline based on a systematic review of six observational studies evaluating scoring systems in identifying and ruling out GAS.
IDSA provided examples of three scoring systems that could aid in determining patients’ risk for GAS: Centor, McIsaac and FeverPAIN. The scoring systems use clinical features including cough, swollen lymph nodes, fever, tonsillar swelling, symptom duration and patient age to determine whether a patient is at high, intermediate or low risk for GAS pharyngitis. Factors that increase patients’ risk status included absence of cough, fever, and swollen tonsils and lymph nodes.
The researchers specified that this guideline does not apply to children aged younger than 3 years because GAS can manifest differently in young children.
The goal of the guideline is to reduce testing for patients with low risk for GAS, which may lead to false positive results and unnecessary antibiotic treatment, Barshak said.
“It also drives up costs of care and leads to increased risks for adverse effects from antibiotics and increasing rates of antimicrobial resistance,” Barshak said. “By using a scoring system to guide the decision about testing, we anticipate that many patients with pharyngitis will not need testing and that there will be fewer cases of treatment directed at test results that are most likely falsely positive.”
“Testing may also decrease risks of implicit or other biases by encouraging consistent and standardized decision-making regarding testing for GAS,” she added.
Barshak noted that the recommendation is conditional with a very low certainty of evidence because the studies had small sample sizes and were lacking uniformity or complete data sets. Some of the studies were old enough that they may not accurately reflect clinical practice today, she added.
Next, IDSA is planning to update the guideline for diagnostic testing and treatment of patients with GAS.
For more information:
Miriam B. Barshak, MD, can be reached through Alex Cornbrooks at acornbrooks@messagepartnersPR.com.
Sources/Disclosures
Source:
Clinical practice guideline update by the Infectious Diseases Society of America on group A streptococcal (GAS) pharyngitis. https://www.idsociety.org/practice-guideline/streptococcal-pharyngitis2/. Published Oct. 14, 2025. Accessed Dec. 24, 2025.
Reference:
Disclosures:
Barshak reports owning stocks and bonds with Boston Scientific and Danaher, previously owning stocks and bonds with Pfizer and Viatris, receiving royalties from UpToDate, and serving as a board member for the Massachusetts Infectious Diseases Society. Please see the guideline for all other authors’ relevant financial disclosures.
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