From the Guidelines
Penicillin is the safest medication to treat strep throat in a pregnant person. The recommended regimen is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg orally three times daily for 10 days, as supported by the Infectious Diseases Society of America guidelines 1. For those with a penicillin allergy, cephalexin 500 mg orally four times daily for 10 days is typically the next best option, as long as the allergy is not severe or anaphylactic. These antibiotics are considered pregnancy category B medications, meaning they have shown no evidence of risk in animal studies and have a long history of safe use during pregnancy.
Key Considerations
- It's essential to complete the full course of antibiotics even if symptoms improve before completion to ensure complete eradication of the bacteria.
- Treating strep throat during pregnancy is crucial as untreated strep infections can lead to complications such as rheumatic fever or kidney inflammation, which pose greater risks to both mother and baby than the antibiotics themselves.
- Always inform your healthcare provider about your pregnancy before starting any medication.
Alternative Options
- For patients with a penicillin allergy, other options like cephalexin, cefadroxil, or clindamycin may be considered, as outlined in the guidelines 1.
- However, the choice of antibiotic should be based on the severity of the allergy and the potential risks and benefits of each option.
Safety and Efficacy
- The safety and efficacy of penicillin and other antibiotics in pregnant women have been well-established in various studies, including those published in the Clinical Infectious Diseases journal 1.
- The European position paper on rhinosinusitis and nasal polyps 2020 also supports the use of penicillin and cephalosporin as the safest classes of antibiotics during pregnancy 1.
From the Research
Treatment Options for Strep Throat in Pregnant Individuals
- Penicillin is considered the treatment of choice for strep throat due to its cost, narrow spectrum of activity, and effectiveness 2.
- Amoxicillin is equally effective and more palatable than penicillin 2, 3.
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 3.
- Erythromycin is an option for patients with penicillin allergy, but there is significant resistance to azithromycin and clarithromycin in some parts of the United States 2, 3.
Considerations for Pregnant Individuals
- The safety of medications during pregnancy is a crucial consideration.
- Penicillin and amoxicillin are generally considered safe for use during pregnancy 2, 3.
- First-generation cephalosporins are also considered safe for use during pregnancy, but the risk of allergy should be carefully evaluated 3.
- It is essential to consult with a healthcare provider to determine the best course of treatment for strep throat during pregnancy.
Diagnostic Methods and Clinical Guidelines
- Clinical scoring systems, rapid antigen detection tests, and throat culture can be used to diagnose strep throat 4, 5.
- Clinical guidelines recommend using clinical decision rules to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 3, 5.
- The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 2.