Primary care · 5-minute playbook

Adult sore throat

A test-directed workflow for uncomplicated adult pharyngitis, with early exits for high-risk presentations.

1. Stabilize first

Escalate immediately for airway compromise, stridor, drooling, inability to handle secretions, toxic appearance, severe dehydration, rapidly progressive neck swelling, or concern for deep-neck infection.

2. Look for a viral syndrome

Cough, rhinorrhea, hoarseness, oral ulcers, and conjunctivitis favor viral illness. When viral symptoms are clear, CDC guidance says GAS testing is not needed.

3. If viral features are absent, test rather than guess

Clinical examination alone cannot reliably distinguish viral from group A streptococcal pharyngitis. Use a rapid antigen detection test or throat culture according to age and local pathway.

4. Treat confirmed GAS

Use an evidence-based regimen only after a positive RADT or culture. Do not treat viral pharyngitis with antibiotics. Review allergy type, renal function, pregnancy, interactions, and local resistance.

5. Close the loop

Give return precautions for breathing or swallowing difficulty, dehydration, neck swelling, worsening systemic illness, or failure to improve. Reassess the diagnosis when the course is atypical.