Treatment of Pharyngeal Group G Streptococcus
Group G Streptococcus pharyngitis does not require antibiotic treatment, as it is not associated with acute rheumatic fever or post-streptococcal glomerulonephritis—the primary justifications for treating streptococcal pharyngitis. 1
Why Antibiotics Are Not Indicated
The Infectious Diseases Society of America guidelines define streptococcal pharyngitis requiring treatment as infection with Streptococcus pyogenes (Group A Streptococcus) exclusively, and all antibiotic recommendations apply only to this organism. 1 Group G Streptococcus lacks the established links to acute rheumatic fever and suppurative complications that justify antibiotic therapy. 1
Recommended Management Approach
Provide symptomatic management only using acetaminophen or NSAIDs for moderate to severe symptoms or high fever. 1 Avoid aspirin in children due to Reye syndrome risk. 1
Patient Education Points
- Advise patients that pharyngitis is typically self-limited, with symptoms resolving within 3-7 days regardless of etiology. 1
- Explain that antibiotics would provide no benefit and carry risks including adverse effects and promotion of antibiotic resistance. 1
When to Reconsider the Diagnosis
If clinical suspicion for Group A Streptococcus remains high despite the Group G result, consider laboratory error or contamination. 1 Repeat testing with a rapid antigen detection test (RADT) or throat culture specifically for Group A Streptococcus should be performed. 1
Re-evaluate immediately if clinical deterioration occurs, such as signs of suppurative complications (peritonsillar abscess, cervical lymphadenitis) or systemic toxicity, as this should prompt testing for Group A Streptococcus or other bacterial pathogens. 1
Critical Pitfalls to Avoid
- Do not prescribe antibiotics "just to be safe" for Group G Streptococcus, as this offers no benefit and promotes antibiotic resistance. 1
- Do not use broad-spectrum antibiotics for Group G Streptococcus, as only Group A Streptococcus has established links to complications requiring antibiotic therapy. 1
- Do not assume all beta-hemolytic streptococci require treatment—only Group A Streptococcus has proven benefit from antibiotic therapy for pharyngitis. 1