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American College of Physicians (ACP) published guidelines for the diagnosis and treatment of acute pharyngitis in adults in 2001. The objective of this study is to characterize antibiotic prescribing patterns in the USA for acute pharyngitis and evaluate concordance with the 2001 ACP pharyngitis treatment guidelines.Patients aged ≥18 years identified with acute pharyngitis via diagnosis codes (ICD-9 CM) were identified from data collected annually (1996–2006) by the National Center for Health Statistics and Centers for Disease Control and Prevention from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Total US office visits for acute pharyngitis were estimated. Logistic regression was performed to determine whether antibiotic prescribing was associated with the publishing of the ACP guidelines.A total of 3791 office visits met study criteria. We extrapolated 78.0 million visits for acute pharyngitis from 1996 to 2006. Antibiotics were prescribed in 62.6% of cases and 7.5% of cases received ACP-recommended antibiotics. There was a significant decrease in the rate of antibiotic prescriptions from 66.5% to 59.1% after publication of ACP guidelines. Univariate analysis showed that antibiotic prescribing decreased by 27% (OR = 0.73, 95% CI 0.55–0.95, P = 0.021). Multivariate analyses confirmed this finding (OR = 0.72, 95% CI 0.56–0.94, P = 0.014). The prescribing of ACP-recommended antibiotics did not significantly change (8.5% to 6.6%, P = 0.519).Publishing of ACP guidelines for the diagnosis and treatment of pharyngitis was associated with a decrease in the overall prescribing of antibiotics but not the prescribing of ACP-recommended antibiotics.