Pharyngeal colonization with group A streptococci occurs in up to 20% of children and is a risk factor for developing streptococcal pharyngitis after a break in mucosal

integrity. Clinicians should recognize that the symptoms of streptococcal pharyngitis usually are self-limited and resolve within 2 to 4 days of onset without treatment.36 Historically, untreated or inappropriately treated disease caused acute rheumatic fever, potential permanent heart valve damage, and infectious complications such as peritonsillar and retropharyngeal abscesses. Delayed antimicrobial therapy given up to

9 days after symptom onset can prevent these particular sequelae, so proper diagnosis is important to minimize unnecessary antimicrobial use for viral disease and complications of untreated streptococcal infection36,37

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