Direct contact with oral or respiratory secretions transmits the organism, andcrowding enhances transmission. Patients remain infected for weeks aftersymptomatic resolution of pharyngitis and may serve as a reservoir forinfecting others. Penicillin treatment shortens the clinical course ofstreptococcal pharyngitis and more importantly prevents the major sequelae.Penicillin remains the antibiotic of choice. Intramuscular penicillin is preferredas it is more effective than oral penicillin and results in better compliance. Arecent Cochrane meta-analysis confirmed that injections every two or threeweeks were more effective than injections every four weeks. The evidence,however, is based on poor quality trials