What is the treatment for a positive beta hemolytic strep (Group A Streptococcus) sputum culture?

From the Guidelines

The treatment for a positive beta hemolytic strep (Group A Streptococcus) sputum culture is typically penicillin as first-line therapy, with oral penicillin V 500 mg twice daily for 10 days being the recommended regimen for adults, as supported by the Infectious Diseases Society of America guidelines 1.

Key Considerations

• For patients with penicillin allergy, alternative options such as macrolides (e.g., azithromycin) or clindamycin can be used, as outlined in the guidelines 1.
• It is crucial to complete the full course of antibiotics, even if symptoms improve before completion, to prevent complications like rheumatic fever or post-streptococcal glomerulonephritis, as emphasized in the studies 1.
• Group A Streptococcus remains universally susceptible to penicillin, which works by inhibiting bacterial cell wall synthesis, making it an effective treatment option 1.

Treatment Regimens

• Oral penicillin V: 500 mg twice daily for 10 days for adults, as recommended by the guidelines 1.
• Amoxicillin: 500 mg three times daily for 10 days, as an alternative to penicillin V 1.
• Azithromycin: 500 mg on day 1, then 250 mg daily for 4 more days, for patients with penicillin allergy 1.
• Clindamycin: 300 mg three times daily for 10 days, for patients with penicillin allergy 1.

Special Considerations

• For patients with severe symptoms or complications such as pneumonia, intravenous antibiotics (e.g., penicillin G) may be necessary, followed by oral therapy to complete the course, as suggested by the guidelines 1.
• The treatment should begin promptly after diagnosis to reduce symptom duration and prevent spread to others, as emphasized in the studies 1.

From the FDA Drug Label

Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only) It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcusto prevent the occurrence of acute rheumatic fever.

The treatment for a positive beta hemolytic strep (Group A Streptococcus) sputum culture is amoxicillin for at least 10 days to prevent the occurrence of acute rheumatic fever, as long as the isolate is susceptible to amoxicillin (β-lactamase–negative) 2.

• The dosage for adults and pediatric patients is as follows:
  • For mild/moderate infections: 500 mg every 12 hours or 250 mg every 8 hours for adults, and 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for pediatric patients.
  • For severe infections: 875 mg every 12 hours or 500 mg every 8 hours for adults, and 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for pediatric patients.
• Alternatively, penicillin can be used for the treatment of streptococcal infections, with a minimum treatment duration of 10 days to eliminate the organism 3.

From the Research

Treatment for Beta Hemolytic Strep Sputum Culture

• The treatment for a positive beta hemolytic strep (Group A Streptococcus) sputum culture typically involves antibiotics 4, 5, 6, 7, 8.
• Penicillin and amoxicillin are commonly recommended as first-line antibiotics for the treatment of Group A beta-hemolytic streptococcal pharyngitis, with a recommended course of 10 days 6, 8.
• For patients with nonanaphylactic allergies to penicillin, first-generation cephalosporins are recommended 8.
• Cefpodoxime has been shown to be effective in treating Group A beta-hemolytic streptococcal tonsillopharyngitis in children, with a 5-day or 10-day course being more efficacious than a 10-day course of penicillin V 7.
• Azithromycin and clarithromycin are not recommended due to significant resistance in some parts of the United States 8.
• Steroids are not recommended for symptomatic treatment of streptococcal pharyngitis 8.

Antibiotic Treatment Comparison

• A study comparing oral and intravenous antibiotic therapy for beta-hemolytic streptococcal bloodstream infections found that intravenous therapy may be superior to oral therapy 4.
• A review of different antibiotic treatments for Group A streptococcal pharyngitis found that cephalosporins and macrolides may be as effective as penicillin, but the evidence is uncertain 6.
• Another study found that carbacephem may be more effective than penicillin for symptom resolution in adults and children with Group A beta-hemolytic streptococcal tonsillopharyngitis 6.

Treatment Duration and Follow-up

• The recommended duration of antibiotic treatment for Group A beta-hemolytic streptococcal pharyngitis is 10 days 6, 8.
• Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 8.
• Tonsillectomy is rarely recommended as a preventive measure, and is typically considered for patients with recurrent episodes of streptococcal pharyngitis 8.