This article briefly summarises the arguments for and against the routine use of rapid antigen testing for group A β-haemolytic streptococcal pharyngitis and the deficiencies in the current evidence base in this area. Currently, most commercial tests are immunoassays with a sensitivity of 70–95% (average 85%) and a specificity of 95–99%, depending on the comparator and patient population. Rapid antigen testing is recommended and commonly used in the USA, especially for patients in whom group A β-haemolytic streptococcal infection is clinically likely or who have any symptoms plus direct contact exposure. However, there is no consensus in Europe regarding the role of rapid testing. There remains a need for randomised trials to evaluate its benefit to patients and its cost-effectiveness compared with the main alternatives, including delayed antibiotic prescribing.