What is the recommended antibiotic treatment, including drug, duration, frequency, and dose, for acute pharyngitis (strep throat) in adults?

From the Guidelines

For adult strep throat treatment, the recommended first-line antibiotic is penicillin V potassium, 250 mg orally four times daily, or 500 mg orally twice daily, for 10 days, as supported by the Infectious Diseases Society of America guidelines 1. Alternatively, amoxicillin 500 mg orally twice daily for 10 days can be used and may be preferred due to better taste and easier dosing schedule. For penicillin-allergic patients, use azithromycin 500 mg orally once daily for 5 days, or clindamycin 300 mg orally three times daily for 10 days. It's crucial to complete the full course of antibiotics even if symptoms improve, to prevent recurrence and complications. Patients should also rest, stay hydrated, and can use over-the-counter pain relievers like acetaminophen or ibuprofen for symptom relief. These antibiotics are effective because they target Group A Streptococcus, the bacteria causing strep throat. Penicillin and amoxicillin work by interfering with cell wall synthesis, while azithromycin and clindamycin inhibit bacterial protein synthesis. The 10-day duration ensures complete eradication of the bacteria, reducing the risk of rheumatic fever and other complications, as emphasized by the American College of Physicians and the Centers for Disease Control and Prevention 1. The American Heart Association also recommends these treatment regimens for the prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis 1.

Some key points to consider:

• The diagnosis of strep throat should be confirmed by rapid antigen detection test and/or culture for group A Streptococcus before initiating antibiotic treatment 1.
• Antibiotics are not recommended for chronic group A Streptococcus carriers, as they are unlikely to spread infection to close contacts and are at little or no risk for complications 1.
• Tonsillectomy solely to reduce the frequency of group A streptococcal pharyngitis in adults is not recommended 1.
• The use of narrow-spectrum antibiotics, such as penicillin and amoxicillin, is preferred to minimize the risk of antimicrobial resistance and reduce the risk of adverse effects 1.

From the FDA Drug Label

It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained. For adults, the recommended dosage for Streptococcal Infections is 500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections, and 875 mg every 12 hours or 500 mg every 8 hours for severe infections.

The recommended antibiotic treatment for acute pharyngitis (strep throat) in adults is:

• Amoxicillin: 500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections, and 875 mg every 12 hours or 500 mg every 8 hours for severe infections.
• Penicillin VK: 125 to 250 mg every 6 to 8 hours for 10 days. The treatment should be continued for at least 10 days to prevent the occurrence of acute rheumatic fever, and for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained 2 3.

From the Research

Recommended Antibiotic Treatment for Acute Pharyngitis (Strep Throat) in Adults

• The recommended first-line treatment for Group A beta-hemolytic streptococcal (GABHS) pharyngitis in adults is a 10-day course of penicillin or amoxicillin 4.
• Patients allergic to penicillin can be treated with first-generation cephalosporins, clindamycin, or macrolide antibiotics 4.
• Amoxicillin administered once daily is not inferior to other dosages of the same antibiotic or penicillin V 5.
• A 10-day treatment regimen is recommended, as a 5-day treatment regimen has been shown to result in a higher rate of recurrences 6.
• The specific dosage and frequency of antibiotic treatment may vary, but penicillin V is often prescribed at a dose of 1000 mg three times daily for 10 days 7.

Alternative Treatment Options

• Nonsteroidal anti-inflammatory drugs are more effective than acetaminophen and placebo for treatment of fever and pain associated with GABHS pharyngitis 4.
• Medicated throat lozenges used every two hours are also effective in treating symptoms 4.
• Corticosteroids provide only a small reduction in the duration of symptoms and should not be used routinely 4.

Importance of Appropriate Antibiotic Use

• The frequency of antibiotic use for pharyngitis has greatly exceeded the prevalence of GABHS, highlighting the need for appropriate antibiotic use 8.
• Nonrecommended antibiotics, such as extended-spectrum macrolides and extended-spectrum fluoroquinolones, are often used, which can contribute to antibiotic resistance 8.