What are the discharge instructions for a patient diagnosed with strep throat?

From the Guidelines

For strep throat, complete the full 10-day course of prescribed antibiotics, such as penicillin or amoxicillin, as recommended by the Infectious Diseases Society of America 1. The antibiotic regimen should be taken as directed, even if symptoms improve before finishing, to ensure the complete elimination of the Streptococcus bacteria and prevent complications like rheumatic fever or kidney inflammation. For pain and fever management, patients can take acetaminophen or ibuprofen as directed. It is essential to rest at home for 24 hours after starting antibiotics, as the patient remains contagious until then. Staying hydrated with water, warm tea with honey, or clear broths, and eating soft foods like yogurt, applesauce, or soup can help soothe the throat while it heals. Gargling with warm salt water (1/4 teaspoon salt in 8 ounces water) several times daily can reduce inflammation. Replacing the toothbrush after 24-48 hours on antibiotics can prevent reinfection. If symptoms worsen, a rash develops, there is difficulty breathing or swallowing, or fever persists beyond 48 hours of antibiotic treatment, the patient should call their doctor. According to the American College of Physicians and the Centers for Disease Control and Prevention 1, antibiotics should be taken for a duration likely to eradicate group A Streptococcus from the pharynx, usually 10 days, with an appropriate narrow-spectrum antibiotic. Some key points to consider when managing strep throat include:

• Completing the full antibiotic course to prevent complications
• Using analgesic therapy, such as aspirin, acetaminophen, or nonsteroidal anti-inflammatory drugs, to reduce pain
• Staying hydrated and eating soft foods to help the throat heal
• Gargling with warm salt water to reduce inflammation
• Replacing the toothbrush after 24-48 hours on antibiotics to prevent reinfection.

From the FDA Drug Label

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. Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained.

The discharge instructions for a patient diagnosed with strep throat should include:

• A minimum of 10 days of antibiotic treatment to prevent acute rheumatic fever
• Continuing treatment for at least 48 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication is obtained 2
• Patients should be counseled to take the medication exactly as directed and complete the full course of therapy to decrease the effectiveness of the immediate treatment and increase the likelihood that bacteria will develop resistance 3
• Patients should be informed that diarrhea is a common problem caused by antibiotics and to contact their physician if they develop watery and bloody stools (with or without stomach cramps and fever) even after completing the treatment 3

From the Research

Discharge Instructions for Strep Throat

The following are key points to consider when discharging a patient diagnosed with strep throat:

• Medication: Penicillin or amoxicillin are the first-line antibiotics for treating strep throat, with a recommended course of 10 days 4, 5.
• Symptom Management: Patients should be advised to manage their symptoms with analgesics and antipyretics, but steroids are not recommended for symptomatic treatment 5.
• Follow-up: Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 5.
• Prevention: Tonsillectomy is rarely recommended as a preventive measure, and only considered in cases with recurrent episodes of streptococcal pharyngitis 5.
• Contagion: Patients should be advised on how to minimize the risk of contagion, as strep throat is a contagious infection 6.
• Special Considerations: Certain populations, such as Indigenous populations in Canada, may require special considerations for testing and treatment due to a higher risk of acute rheumatic fever 7.

Key Takeaways

• Antibiotics should only be prescribed when a diagnosis of strep throat is confirmed or highly suspected, using clinical decision rules and rapid antigen testing if necessary 4, 5.
• Patients should be educated on the importance of completing the full course of antibiotics to ensure effective treatment and prevent complications 4, 5.
• A careful physical examination and patient history are essential in diagnosing strep throat, and diagnostic methods such as throat culture or rapid antigen detection tests may be used to confirm the diagnosis 4, 6.