What is the recommended treatment for strep throat?

From the Guidelines

The recommended treatment for strep throat is antibiotics, typically penicillin or amoxicillin, as they are effective in reducing symptoms and preventing complications. For adults, the standard regimen 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, the dosage is weight-based, usually 250-500 mg of amoxicillin twice daily for 10 days. For patients with penicillin allergy, alternatives include azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) or clindamycin (300 mg three times daily for 10 days) 1.

It's crucial to complete the full course of antibiotics even if symptoms improve within a few days to prevent recurrence and complications. While waiting for antibiotics to work, over-the-counter pain relievers like acetaminophen or ibuprofen can help manage throat pain and fever, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1. Adequate rest and increased fluid intake are also important.

Some key points to consider when treating strep throat include:

• Accurate diagnosis of streptococcal pharyngitis is important to prevent unnecessary antibiotic use and potential complications 1
• Antibiotics are effective in reducing symptoms and preventing complications, but they should only be prescribed for confirmed streptococcal pharyngitis 1
• Patients with recurrent throat infections may be considered for tonsillectomy, but this should be based on documentation of frequent episodes and other factors, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1

Overall, the goal of treatment for strep throat is to reduce symptoms, prevent complications, and improve quality of life, and antibiotics are a crucial part of this treatment plan.

From the FDA Drug Label

In some infections, therapy may be required for several weeks. It may be necessary to continue clinical and/or bacteriological follow-up for several months after cessation of therapy. 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.

The recommended treatment for strep throat is at least 10 days of antibiotic therapy, such as amoxicillin, to prevent the occurrence of acute rheumatic fever.

• The dosage for adults and pediatric patients is as follows:
  • For patients aged 3 months and older, the recommended dosage 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.
  • For pediatric patients aged less than 12 weeks, the recommended upper dose is 30 mg/kg/day divided every 12 hours.
• Azithromycin can be used as an alternative to first-line therapy in individuals who cannot use first-line therapy, but penicillin is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever 2 3.

From the Research

Treatment Overview

• The recommended treatment for strep throat typically involves antibiotics, with the goal of alleviating symptoms, shortening the duration of the illness, and preventing complications 4.
• Guidelines suggest 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 4.

Antibiotic Options

• Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days 4.
• First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 4.
• Macrolides, such as azithromycin, may be used as an alternative, but there is significant resistance to these antibiotics in some parts of the United States 4.
• Studies have compared the effectiveness of different antibiotics, including penicillin, cephalosporins, and macrolides, with mixed results 5, 6, 7, 8.

Dosage and Duration

• The optimal dosing interval for penicillin treatment of streptococcal pharyngitis is twice daily, with a dose of 500 mg 7.
• Short-course antibiotic treatment (≤5 days) may be as effective as long-course antibiotic treatment (≥7 days) for early clinical cure and bacterial eradication, but the evidence is not conclusive 8.
• A 10-day course of penicillin is generally recommended, but some studies suggest that shorter courses may be effective for certain antibiotics, such as cephalosporins 8.

Adverse Events and Complications

• Adverse events, such as gastrointestinal symptoms, may occur more frequently with short-course antibiotic treatment 8.
• The risk of complications, such as acute rheumatic fever and post-streptococcal glomerulonephritis, is low in high-income countries, but may be higher in low-income countries and Aboriginal communities 6.