Published guidelines, based on expert opinion, generally recommend against identifying and treating carriers except for the following special situations:
(1) a local outbreak of acute rheumatic fever, invasive GAS disease, or poststreptococcal glomerulonephritis;
(2) an outbreak of GAS pharyngitis in a closed or semiclosed community;
(3) family or personal history of acute rheumatic fever;
(4) multiple episodes of GAS pharyngitis occurring in a family for many weeks despite appropriate treatment; and
(5) when tonsillectomy is being considered only because of GAS carriage.