Pharyngitis is the third most common illness diagnosed by pediatricians in the United States. Group A ß-hemolytic streptococci account for only approximately 30% of episodes of symptomatic pharyngitis. A broad list of other pathogens, including both bacteria and viruses, as well as Toxoplasma gondii and Candida species, are suggested frequently as the pathogens responsible for the remaining 70% of cases. This article reviews the evidence for a causative role of ß-hemolytic streptococci other than Streptococcus pyogenes and other bacteria and viruses in outbreaks and sporadic cases of pharyngitis. Recommendations for the diagnosis and management of pharyngitis caused by pathogens other than S pyogenes are offered.