Group A streptococcal pharyngitis is still a common childhood infection and acute rheumatic fever is still prevalent in many parts of the world. Clinical diagnosis is difficult as many other agents may produce similar features but sudden onset of fever, sore throat (pain on swallowing), headache and abdominal pain along with marked inflammation of throat and patchy exudate on tonsils, tender enlarged anterior cervical nodes and scarlatiniform rash are suggestive of streptococcal pharyngitis. Rapid antigen detection tests are specific and very helpful when positive but not sensitive enough to rule out infection when they are negative. At present properly performed throat culture is the best way to confirm clinical suspicion. It is possible that the rapid antigen tests will replace throat cultures in future. Penicillin is still the treatment of choice and an oral preparation given twice daily for 10 days is equally effective. In areas where rheumatic fever is prevalent, especially in poor and crowded populations and where compliance in taking oral penicillin therapy cannot be trusted, treatment with intramuscular benzathine penicillin alone or in combination with procaine penicillin is preferable. In case of penicillin allergy erythromycin is a very good alternative except where erythromycin resistance is common among group A streptococci. In those circumstances clindamycin or first generation cephalosporins may be used. Early antibiotic therapy shortens the course of illness, prevents complications and makes the patients noncontagious. Bacteriologic failures after adequate antibiotic therapy are common and there is no need of routine follow-up throat culture at the end of therapy. In high risk situations, a short course of rifampin may be given in conjunction with penicillin for the eradication of group A streptococci from the pharynx. Tonsillectomy should be reserved for children with frequent episodes of symptomatic streptococcal pharyngitis and not for asymptomatic chronic carriers.