What is the diagnosis and treatment (D/C) for strep throat?

From the Guidelines

Strep throat is diagnosed through a combination of clinical evaluation and laboratory testing, and treatment typically involves a 10-day course of antibiotics, with penicillin V being the first-line treatment, as recommended by the Infectious Diseases Society of America 1.

Diagnosis and Treatment

• A rapid strep test or throat culture can confirm the presence of group A Streptococcus bacteria.
• For penicillin-allergic patients, alternatives include cephalexin, azithromycin, or clindamycin.
• Complete the full antibiotic course even if symptoms improve to prevent complications like rheumatic fever or kidney inflammation.
• Symptomatic relief can be achieved with acetaminophen or ibuprofen for pain and fever, warm salt water gargles, and adequate hydration.

Patient Management

• Patients should rest and stay home for at least 24 hours after starting antibiotics to prevent transmission.
• Antibiotics are crucial for strep throat because they reduce symptom duration, prevent complications, and decrease contagiousness, as the bacteria can cause serious sequelae if left untreated, as noted in the American College of Physicians and the Centers for Disease Control and Prevention guidelines 1.

Special Considerations

• Chronic streptococcal carriers do not ordinarily require further antimicrobial therapy, but may need treatment in special circumstances, such as during a community outbreak of acute rheumatic fever or invasive GAS infection, as outlined in the Infectious Diseases Society of America guidelines 1.
• Differentiating a carrier with an intercurrent non-group A streptococcal infection from a patient with acute streptococcal pharyngitis can be challenging, and may require careful evaluation of the patient's age, season, local epidemiology, and presenting signs and symptoms, as discussed in the Infectious Diseases Society of America guidelines 1.

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. Cultures should be taken following completion of treatment to determine whether streptococci have been eradicated.

The diagnosis of strep throat is typically made through a combination of physical examination, medical history, and laboratory tests, such as throat cultures. The treatment (D/C) for strep throat usually involves a ten-day course of antibiotics, such as penicillin, to eliminate the streptococcal organism and prevent potential complications 2. Azithromycin may be used as an alternative to first-line therapy in individuals who cannot use first-line therapy, but susceptibility tests should be performed to ensure the effectiveness of the treatment 3. Key points to consider in the treatment of strep throat include:

• Completing the full course of antibiotic therapy
• Monitoring for potential side effects, such as diarrhea or allergic reactions
• Following up with a healthcare provider to ensure the infection has been fully eradicated.

From the Research

Diagnosis of Strep Throat

• The diagnosis of strep throat can be made using clinical decision rules, such as the modified Centor score, followed by rapid antigen testing if a diagnosis is unclear 4, 5, 6.
• A throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly 4.
• The strongest independent predictors of GABHS pharyngitis are patient age of five to 15 years, absence of cough, tender anterior cervical adenopathy, tonsillar exudates, and fever 6.

Treatment of Strep Throat

• Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice for strep throat because of cost, narrow spectrum of activity, and effectiveness 4, 7.
• Amoxicillin is equally effective and more palatable than penicillin 4, 5.
• First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 5, 6.
• Corticosteroids are not recommended for symptomatic treatment, as they provide only a small reduction in the duration of symptoms 6.

Management and Prevention

• Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 5.
• Tonsillectomy is rarely recommended as a preventive measure, and is typically considered for patients with recurrent episodes of streptococcal pharyngitis 5.
• Chronic GABHS colonization is common despite appropriate use of antibiotic therapy, but chronic carriers are at low risk of transmitting disease or developing invasive GABHS infections 4.