The aim of this guideline is to propose a diagnostic and therapeutic approach to manage sore throat in ambulatory care. Relevant literature on the treatment of sore throat in primary care was retrieved and evaluated. During its development, the guidelines underwent a panel test, a practice test and a consensus conference. Sore throat is mostly a short, self-limiting infection. Accurate etiologic diagnosis is generally not possible. Routine antibiotic treatment of sore throat for the prevention of complications is currently not indicated. The effect of antibiotics on symptoms and duration of disease is, at best, moderate. It is more pronounced in patients with typical clinical symptoms and signs of pharyngitis caused by group A streptococci (GAS) and slightly more pronounced again in cases of additional positive throat swab for GAS. An algorithm for decision-making is proposed. Rapid testing for streptococcal antigen or a culture for GAS is only recommended if the result is likely to influence therapeutic decision-making. Patients with more severe illness and signs of GAS pharyngitis can be given antibiotic therapy for symptomatic relief.