From the Guidelines
The best treatment for strep throat is antibiotics, specifically penicillin or amoxicillin, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- For adults, the typical regimen is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days.
- For children, dosing is weight-based, usually amoxicillin 50 mg/kg/day divided into two or three doses.
- For those with penicillin allergy, alternatives include cephalexin (if no anaphylactic reaction history) or macrolides like azithromycin (250-500 mg daily for 5 days) 1.
Importance of Completing the Full Course
It's crucial to complete the full course of antibiotics even if symptoms improve within a few days, as this ensures the elimination of the Streptococcus pyogenes bacteria and prevents complications like rheumatic fever and kidney inflammation 1.
Additional Relief Measures
Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage throat pain and fever, while gargling with warm salt water (1/4 teaspoon salt in 8 ounces of water) and drinking plenty of fluids also provide relief 1.
Prevention of Complications
Antibiotics are essential for preventing complications like rheumatic fever and kidney inflammation, and for reducing contagiousness after 24 hours of treatment 1.
Evidence-Based Recommendations
The recommendations are based on the most recent and highest-quality studies, including the 2012 update by the Infectious Diseases Society of America 1, which provides evidence-based guidelines for the diagnosis and management of group A streptococcal pharyngitis.
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. 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.
The best treatment for strep throat is penicillin. It is recommended to take penicillin for a minimum of ten days to eliminate the organism and prevent the sequelae of streptococcal disease 2. Azithromycin can be used as an alternative to first-line therapy in individuals who cannot use first-line therapy 3.
From the Research
Treatment Options for Strep Throat
- The treatment of choice for strep throat is penicillin, due to its cost, narrow spectrum of activity, and effectiveness 4.
- Amoxicillin is equally effective and more palatable than penicillin 4.
- Erythromycin and first-generation cephalosporins are options for patients with penicillin allergy 4.
- A 5-day course of cefuroxime axetil has been shown to be as effective as a 10-day course of penicillin V in treating strep throat in children 5.
- A shortened 5- to 7-day antibiotic regimen has been found to be as effective and safe as the traditional 10-day regimen for acute streptococcal pharyngotonsillitis 6.
Antibiotic Regimens
- Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days 7.
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 7.
- Twice-daily dosing of 10-day penicillin is as efficacious as more frequent dosing regimens in the treatment of strep throat 8.
- Once-daily dosing of penicillin is associated with decreased efficacy and should not be used 8.
Special Considerations
- Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 7.
- Tonsillectomy is rarely recommended as a preventive measure, and is typically considered for patients with recurrent episodes of strep throat 7.