Summary: Acute tonsillopharyngitis is one of the most common reasons for prescribing antibiotics in children, even though most infections are of viral origin. Based on clinical symptoms alone, it is impossible to determine the etiology of the infection. Therefore, in patients whose clinical presentation suggests streptococcal pharyngitis (Centor/McIsaac score above 2), it is advisable to perform a rapid antigen test for Streptococcus pyogenes and base further management on the test result. It is important to remember that no test differentiates colonization from infection, so testing should not be performed on patients with typical symptoms of a viral infection (rhinitis, cough, conjunctivitis). Given the full susceptibility of S. pyogenes, proven efficacy, and narrow spectrum, phenoxymethylpenicillin remains the drug of choice for streptococcal pharyngitis in Poland. Recently, a new formulation of phenoxypenicillin in the form of potassium salt has been introduced for use in children. It is characterized by better bioavailability and achieves higher blood concentrations compared to the benzathine salt. Because of the overly broad spectrum, and thus higher risk of resistance selection and microbiota damage, other beta-lactam antibiotics or macrolides should not be used as first-line treatment. The latter are recommended only for patients with immediate hypersensitivity reactions to penicillin. Traditionally, the duration of treatment for streptococcal pharyngitis is 10 days (except for azithromycin, which is used for 5 days), but studies indicate that shorter therapy is also effective (although shorter penicillin treatment less frequently leads to S. pyogenes eradication). Currently, WHO recommendations for the duration of penicillin use depend on the risk of rheumatic fever – in low-risk populations, it is 5 days, and in high-risk populations – 10 days. The trend to shorten treatment duration is also evident in some European guidelines (e.g., British and German), where the main goal of antibiotic therapy is to reduce symptom duration and infectivity, rather than preventing complications, which are very rare in these countries.