From the Guidelines
The recommended treatment for strep throat is antibiotics, specifically penicillin or amoxicillin, as they reduce symptom duration, decrease contagiousness, and prevent serious complications like rheumatic fever and kidney inflammation. 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.
Key Considerations
- For patients with penicillin allergy, alternatives include clindamycin (300 mg three times daily for 10 days) or azithromycin (500 mg on day one, then 250 mg daily for four more days) 1.
- It's crucial to complete the full course of antibiotics even if symptoms improve before finishing the medication.
- Alongside antibiotics, supportive care includes rest, adequate hydration, over-the-counter pain relievers like acetaminophen or ibuprofen for fever and throat pain, and warm salt water gargles.
- Patients should stay home from work or school until they've been on antibiotics for at least 24 hours and no longer have fever.
Diagnosis and Treatment Approach
- The diagnosis of strep throat should be established through a rapid antigen detection test and/or culture for group A Streptococcus, especially in patients with symptoms suggestive of group A streptococcal pharyngitis 1.
- The Centor clinical scoring system can help identify patients with a higher likelihood of group A streptococcal infection, and a rapid antigen test can be used to confirm the diagnosis 1.
- Antibiotics should only be used in patients with confirmed streptococcal pharyngitis, as they have modest benefits in reducing symptom duration and preventing complications, but also have potential side effects and contribute to antibiotic resistance 1.
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 amoxicillin for at least 10 days to prevent the occurrence of acute rheumatic fever.
- The dosage for adults and pediatric patients is as follows:
- For patients 3 months or older and weighing less than 40 kg: 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for mild/moderate infections, and 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for severe infections.
- For patients weighing 40 kg or more: 500 mg every 12 hours or 250 mg every 8 hours for mild/moderate infections, and 875 mg every 12 hours or 500 mg every 8 hours for severe infections.
- 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 2.
From the Research
Strep Throat Treatment Overview
- Strep throat, also known as streptococcal pharyngitis, is a common infection that requires proper antibiotic treatment to prevent complications such as acute rheumatic fever 3.
- The diagnosis of strep throat is typically made using a combination of clinical evaluation, rapid antigen detection tests, and throat culture 4, 3.
Diagnostic Methods
- Clinical scoring systems, such as the modified Centor score, can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 4.
- Rapid antigen detection tests and throat culture are commonly used diagnostic methods, with throat culture considered the diagnostic standard 4, 3.
- Nucleic acid amplification tests and machine learning and artificial intelligence are also being explored as diagnostic methods for strep throat 3.
Antibiotic Treatment
- Penicillin and amoxicillin are first-line antibiotics for the treatment of strep throat, with a recommended course of 10 days 5, 4.
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 5, 4.
- Shorter antibiotic courses, such as 5-7 days, have been shown to be effective and safe in some studies 6.
- Once-daily amoxicillin has been compared to intramuscular benzathine penicillin G in low-resource settings, with mixed results 7.
Treatment Considerations
- Antibiotics should only be prescribed for patients with a confirmed diagnosis of strep throat, as overuse of antibiotics can contribute to resistance 5, 3.
- 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 for strep throat, and is typically considered only for patients with recurrent episodes 5, 4.