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IDSA Updates Guidance on Strep Throat Testing with New Scoring System
Clinicians should now utilize clinical scoring systems to determine which patients require testing for group A streptococcal (GAS) pharyngitis, according to updated guidance released by the Infectious Diseases Society of America (IDSA).
The IDSA’s updated recommendations,the first since 2012,aim to reduce unnecessary antibiotic prescriptions and testing for strep throat. A key component of the new guidance is the implementation of a scoring system to assess a patient’s likelihood of having GAS.
“The suggestion is to use a clinical scoring system as part of the evaluation of patients with sore throat,” explained Miriam B. Barshak, MD, an infectious disease specialist at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School in Boston. “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.”
dr. Barshak and colleagues based their conditional guideline on a systematic review of six observational studies evaluating the effectiveness of scoring systems in identifying and ruling out GAS. The IDSA highlighted three specific scoring systems – Centor, McIsaac, and FeverPAIN – that clinicians can utilize. These systems consider factors such as cough, swollen lymph nodes, fever, tonsillar swelling, symptom duration, and patient age to categorize patients as high, intermediate, or low risk for GAS pharyngitis. Notably, the absence of cough, fever, and swollen tonsils and lymph nodes are indicators of increased risk.
The guidance clarifies that these recommendations do not apply to children younger than 3 years old, as GAS can present differently in this age group.
A primary goal of the updated guidance is to minimize testing in low-risk patients, thereby reducing the potential for false positive results and subsequent unnecessary antibiotic treatment. “It also drives up costs of care and leads to increased risks for adverse effects from antibiotics and increasing rates of antimicrobial resistance,” Dr. Barshak stated. “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.”
furthermore, standardized testing decisions driven by scoring systems may mitigate implicit biases. “Testing may also decrease risks of implicit or other biases by encouraging consistent and standardized decision-making regarding testing for GAS,” Dr. barshak added.
Though, the recommendation is considered conditional due to the limited certainty of evidence, stemming from small sample sizes and inconsistencies in the reviewed studies. Dr. Barshak also noted that some of the studies were older and may not fully reflect current clinical practices. The IDSA is planning a future update to the guideline focusing on diagnostic testing and treatment protocols for GAS.
For further information, Miriam B. Barshak, MD, can be contacted through Alex Cornbrooks at [email protected].
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.
Disclosure: Dr.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.
