the Centor criteria have a low positive predictive value for determining the presence of group A streptococcal infection, the IDSA suggests that they can be used to identify patients who have a low probability of group A streptococcal pharyngitis and do not warrant further testing. Patients who meet fewer than 3 Centor criteria do not need to be tested. Those who present with unusually severe signs and symptoms, such as difficulty swallowing, drooling, neck tenderness, or swelling, should be evaluated for rare throat infections (such as peritonsillar abscess, parapharyngeal abscess, epiglottitis, or Lemierre syndrome).
Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.
Source: Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults
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