From the Guidelines
No, a single shot of ROC (Rocephin, or ceftriaxone) is not the recommended treatment for strep throat (Group A Streptococcus pharyngitis). The standard treatment for strep throat is oral penicillin V (250-500 mg 2-3 times daily for 10 days) or amoxicillin (50 mg/kg once daily, maximum 1000 mg, for 10 days) as recommended by the Infectious Diseases Society of America 1. For patients with penicillin allergy, alternatives include first-generation cephalosporins, clindamycin, clarithromycin, or azithromycin. While ceftriaxone is effective against strep, it's typically reserved for more severe infections or when oral therapy isn't possible.
Strep throat requires a complete course of antibiotics (usually 10 days) to fully eradicate the bacteria, prevent complications like rheumatic fever or kidney inflammation, and reduce contagiousness. A single shot of any antibiotic, including ceftriaxone, would likely not provide sufficient duration of treatment to completely eliminate the infection. According to the guidelines, benzathine penicillin G is an option for treatment, but it is given as a single dose of 600,000 U for patients weighing less than 27 kg and 1,200,000 U for patients weighing 27 kg or more 1. However, this is not the same as ceftriaxone, and the treatment duration and dosage are specific to the type of antibiotic used.
The European Society of Cardiology guidelines for the management of infective endocarditis also recommend a 4-week duration of antibiotic treatment for streptococcal endocarditis, with options including penicillin G, amoxicillin, and ceftriaxone 1. However, these guidelines are specific to the treatment of endocarditis, not strep throat, and the recommended treatment duration and dosage are different from those for strep throat.
In summary, a single shot of ROC is not sufficient to treat strep throat, and a complete course of antibiotics is necessary to fully eradicate the bacteria and prevent complications. The choice of antibiotic and treatment duration should be based on the patient's specific needs and medical history, and should be guided by current clinical guidelines and recommendations from reputable medical organizations.
From the FDA Drug Label
In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes) Azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates (for the combined evaluable patient with documented GABHS): Three U. S. Streptococcal Pharyngitis Studies Azithromycin vs. Penicillin V EFFICACY RESULTS Day 14Day 30 Bacteriologic Eradication: Azithromycin323/340 (95%)255/330 (77%) Penicillin V242/332 (73%)206/325 (63%) Clinical Success (Cure plus improvement): Azithromycin336/343 (98%)310/330 (94%) Penicillin V284/338 (84%)241/325 (74%)
The answer to the question of whether one shot of azithromycin will treat positive strep is no, because the label does not support the use of a single dose for this indication, instead, it was given once a day for 5 days 2.
From the Research
Effectiveness of One Shot of ROC in Treating Positive Strep
- There is no direct evidence in the provided studies to support the effectiveness of one shot of ROC in treating positive strep.
- However, studies have investigated the effectiveness of different antibiotics, including azithromycin, in treating group A beta-haemolytic streptococcal pharyngitis/tonsillitis 3, 4.
- A study found that a single 2-g dose of azithromycin extended-release is as effective and well tolerated as 3 days of azithromycin immediate-release (500 mg once daily) for treating group A beta-haemolytic streptococcal pharyngitis/tonsillitis in adults and adolescents 3.
- Another study compared azithromycin with amoxicillin in children and found that azithromycin in a single dose may be as effective as amoxicillin for 10 days, but the evidence is of very low certainty 4.
- The American Academy of Family Physicians recommends penicillin and amoxicillin as first-line antibiotics for the treatment of streptococcal pharyngitis, with a recommended course of 10 days 5.
- A meta-analysis found that twice-daily dosing of 10-day penicillin is as efficacious as more frequent dosing regimens in the treatment of streptococcal tonsillopharyngitis, but once-daily dosing of penicillin is associated with decreased efficacy 6.
- Another meta-analysis found that amoxicillin administered once daily is not inferior to other dosages of the same antibiotic or penicillin V in the treatment of streptococcal tonsillitis 7.