What is the treatment for Streptococcus A (Strep A) infection?

From the Guidelines

Strep A infections are typically treated with antibiotics, primarily penicillin or amoxicillin, to reduce morbidity, mortality, and improve quality of life by preventing complications like rheumatic fever or kidney inflammation. The standard treatment for adults is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days, as recommended by the Infectious Diseases Society of America 1. For children, amoxicillin 50 mg/kg/day divided into two or three doses for 10 days is recommended. If a patient has a penicillin allergy, alternatives include clindamycin (300 mg three times daily for adults), azithromycin (500 mg on day 1, then 250 mg daily for 4 more days), or a first-generation cephalosporin like cephalexin (if no history of anaphylaxis to penicillin) 1.

Some key points to consider when treating Strep A infections include:

• Completing the full course of antibiotics even if symptoms improve within a few days to prevent complications
• Resting, drinking plenty of fluids, using throat lozenges or warm salt water gargles for pain relief, and taking acetaminophen or ibuprofen as needed for fever and discomfort
• Antibiotics work by killing the Streptococcus pyogenes bacteria that cause the infection, and patients typically become non-contagious after 24 hours of antibiotic treatment
• Penicillin remains the treatment of choice due to its proven efficacy, safety, narrow spectrum, and low cost 1
• For patients with aggressive infections or suspicion of necrotizing fasciitis, prompt surgical consultation and broad empiric antibiotic treatment may be necessary 1

It's essential to note that while multiple studies support the use of various antibiotics for Strep A treatment, the most recent and highest quality studies should be prioritized when making treatment decisions. In this case, the 2014 update by the Infectious Diseases Society of America provides strong, low-level recommendations for the treatment of skin and soft tissue infections, including those caused by group A streptococci 1.

From the FDA Drug Label

In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur. Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx

Strep A Treatment:

• The recommended treatment for streptococcal infections, including Strep A, is penicillin for a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease 2.
• Azithromycin can be used as an alternative to first-line therapy in individuals who cannot use first-line therapy, but susceptibility tests should be performed to ensure the strain is susceptible to azithromycin 3.

From the Research

Treatment Options for Strep A

• The treatment of Strep A infections often involves the use of antibiotics, with penicillin being the traditional drug of choice 4, 5, 6.
• However, some studies have suggested that penicillin may not be effective in eradicating Strep A from the throat, especially in cases where the bacteria have invaded epithelial cells 7.
• Alternative antibiotics such as clindamycin, erythromycin, and azithromycin have been shown to be more effective in killing ingested Strep A in some studies 4, 7.
• The choice of antibiotic may also depend on the specific strain of Strep A and its susceptibility to different antibiotics 8.

Antibiotic Resistance

• There is growing concern about antibiotic resistance in Strep A infections, with some studies reporting high levels of resistance to penicillin and other antibiotics 8.
• The spread of antibiotic resistance genes from one species of bacteria to another is a major concern, and highlights the need for careful antibiotic stewardship 8.

Clinical Implications

• The treatment of Strep A infections requires careful consideration of the potential benefits and risks of different antibiotics 5, 6.
• Clinicians should be aware of the potential for antibiotic resistance and take steps to minimize its development, such as using narrow-spectrum antibiotics and avoiding unnecessary antibiotic use 8, 6.