From the Guidelines
A Z-Pak (azithromycin) can be used to treat strep throat, but only in patients who are allergic to penicillin, due to increasing resistance of Group A Streptococcus to azithromycin in some regions. The recommended dosage for azithromycin is 12 mg/kg once daily (max = 500 mg) for 5 days, as stated in the 2012 update by the Infectious Diseases Society of America 1.
Key Considerations
- For patients without penicillin allergy, the first-line treatment is penicillin V 250 mg twice daily or 500 mg twice daily for 10 days, or amoxicillin 50 mg/kg once daily (max = 1000 mg) for 10 days 1.
- It's essential to confirm the diagnosis of streptococcal infection through a throat culture or rapid strep test before starting any antibiotic, as most sore throats are caused by viruses that don't respond to antibiotics.
- Complete treatment is crucial, even if symptoms improve before finishing the medication, to prevent complications like rheumatic fever and kidney inflammation.
Treatment Options
- Penicillin V: 250 mg twice daily or 500 mg twice daily for 10 days
- Amoxicillin: 50 mg/kg once daily (max = 1000 mg) for 10 days
- Azithromycin: 12 mg/kg once daily (max = 500 mg) for 5 days (for patients with penicillin allergy)
Important Notes
- Resistance of Group A Streptococcus to azithromycin is well-known and varies geographically and temporally, making penicillin the preferred first-line treatment 1.
- Accurate diagnosis and appropriate antimicrobial therapy are crucial to prevent acute rheumatic fever, suppurative complications, and minimize potential adverse effects of inappropriate antimicrobial therapy 1.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy NOTE: 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 Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin.
Yes, a Z-Pak (azithromycin) can be used to treat strep (Streptococcus pyogenes) as an alternative to first-line therapy in individuals who cannot use first-line therapy. However, penicillin is the usual drug of choice, and susceptibility tests should be performed due to potential resistance to azithromycin 2.
From the Research
Treatment Options for Strep Throat
- The American family physician recommends penicillin and amoxicillin as first-line antibiotics for treating strep throat, with a recommended course of 10 days 3.
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 3.
- There is significant resistance to azithromycin and clarithromycin in some parts of the United States, which may limit their effectiveness in treating strep throat 3.
Use of Z-Pak for Strep Throat
- A Z-Pak, which contains azithromycin, may not be the best choice for treating strep throat due to significant resistance in some parts of the United States 3.
- The study published in the Annals of emergency medicine found that there is insufficient evidence to show clinically meaningful differences between antibiotics for group A beta hemolytic streptococci tonsillopharyngitis, but recommends penicillin or amoxicillin as the first choice 4.
- The Frontiers in cellular and infection microbiology study notes that antibiotics with narrow spectrums of activity are appropriate for treating strep throat, but does not specifically recommend azithromycin 5.
Diagnosis and Treatment Guidelines
- 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.
- Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 3.