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The cause of acute pharyngitis in children must be determined because untreated streptococcal infection may lead to rheumatic fever. Viral infection, in contrast, cannot be treated by antimicrobial agents. In this article, Dr Feldman examines the various forms and potential causes of acute pharyngitis and discusses what to do when a rapid strep test is negative even though clinical findings are positive. Management of infection due to group A beta-hemolytic streptococci is emphasized.