- To describe how physicians manage acute pharyngitis with respect to the clinical guidelines. The computerised medical records of 105,961 children in one district of a large health maintenance organisation were analysed, to identify children aged 0-18 years with a diagnosis of pharyngitis and paying their first visit for pharyngitis. Main outcome variables were whether a throat culture was performed and the time between their medical consultation and purchasing any antibiotics, if at all. A total of 28,511 episodes of pharyngitis in 19,865 children aged 0 to 18, recorded by 125 physicians, were analysed (average of 1.4 episodes per child). Throat cultures were performed in 14,847 episodes (52%), with tests more common among paediatricians and younger physicians. Antibiotics were purchased in 24.8% of these cases, without knowing the result, and were more commonly associated with male physicians, family practitioners, children living in rural areas and drugs bought before the weekend. About 50% of the physicians did not adhere to the guidelines. Factors influencing adherence included physician training, years in practice and patients' non-medical characteristics. It is suggested that the existing clinical guidelines should address additional modifiers that will make the more applicable in practice. This article is protected by copyright. All rights reserved.