From the Guidelines
Penicillin or amoxicillin is the recommended antibiotic for strep throat in pregnancy, due to their narrow spectrum of activity, infrequency of adverse reactions, and modest cost. 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 this duration is likely to eradicate the organism from the pharynx 1.
Key Considerations
- For pregnant women with a penicillin allergy, alternative antibiotics such as cephalexin or clindamycin may be recommended, depending on the severity of the allergy.
- It's essential to complete the full course of antibiotics, even if symptoms improve before finishing the prescription, to prevent complications such as rheumatic fever or peritonsillar abscess.
- Treating strep throat during pregnancy is crucial to reduce the risk of transmission to the newborn during delivery.
- Penicillin and its alternatives are considered safe during all trimesters of pregnancy and have not been associated with birth defects, as supported by the Infectious Diseases Society of America's 2012 update 1.
Treatment Options
- Penicillin V 500 mg orally twice daily for 10 days
- Amoxicillin 500 mg orally three times daily for 10 days
- Cephalexin 500 mg orally four times daily for 10 days (for non-severe penicillin allergy)
- Clindamycin 300 mg orally three times daily for 10 days (for severe penicillin allergy)
From the Research
Antibiotic Treatment for Strep Throat in Pregnancy
- The use of antibiotics for strep throat in pregnancy is a common practice, with penicillin and amoxicillin being the first-line treatments 2, 3.
- For patients with a penicillin allergy, first-generation cephalosporins are recommended as an alternative 2, 3.
- A study published in 2021 found that penicillin allergy testing was safe and associated with significantly reduced broad-spectrum antibiotic use and increased first-line beta-lactam antibiotic use in pregnant patients 4.
- The American Family Physician recommends 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 2.
- A Cochrane review published in 2021 found that there is low-certainty evidence to support the use of carbacephem over penicillin for symptom resolution in adults and children with GABHS tonsillopharyngitis 5.
Considerations for Antibiotic Use in Pregnancy
- The risk of anaphylaxis with penicillin is estimated to be 5 per 10,000 patients treated with injectable penicillin, although the risk associated with oral penicillin is not quantified 6.
- Antibiotics can affect the bacterial ecology, encouraging resistance among some bacterial species other than group A streptococci 6.
- A strategy based on the use of a clinical diagnostic score, followed by a rapid test if the score is intermediate, seems to be the best way of restricting antibiotics to patients with pharyngitis due to group A streptococci 6.
Recommendations for Antibiotic Treatment
- Penicillin and amoxicillin are recommended as first-line treatments for strep throat in pregnancy 2, 3.
- First-generation cephalosporins are recommended for patients with a non-anaphylactic penicillin allergy 2, 3.
- Azithromycin and clarithromycin are not recommended due to significant resistance in some parts of the United States 2.