From the Guidelines
A patient with streptococcal throat infection should stay home from school or work for 24 hours after starting antibiotic treatment. After this initial 24-hour period on antibiotics, the person is generally no longer contagious and can safely return to normal activities 1. Common antibiotics prescribed for strep throat include penicillin V (typically 500 mg twice daily for 10 days for adults), amoxicillin (500 mg twice daily for 10 days), or azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) for those with penicillin allergies 1. It's crucial that patients complete the entire course of antibiotics even if symptoms improve before the medication is finished. This 24-hour guideline works because antibiotics rapidly reduce the bacterial load in the throat, significantly decreasing the risk of transmission to others. The antibiotics kill the Group A Streptococcus bacteria that cause the infection, preventing complications like rheumatic fever and reducing symptom duration 1. While waiting to return to normal activities, patients should:
- rest
- stay hydrated
- use throat lozenges or warm salt water gargles for pain relief
- avoid sharing utensils or drinks with others. Some key points to consider include:
- Penicillin has a narrow spectrum of activity, long-standing proven efficacy, and is an inexpensive regimen 1
- GAS resistant to penicillin have never been documented 1
- Early diagnosis and therapy may reduce the period of infectivity and morbidity, which would allow the patient to return to normal activity sooner 1.
From the FDA Drug Label
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 FDA drug label does not answer the question.
From the Research
Duration of Stay at Home After Starting Antibiotics
- The American Academy of Pediatrics Committee on Infectious Diseases recommends that patients with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare 2.
- A study published in Pediatrics found that 39 (83%) of the patients became "culture negative" within the first 24 hours of initiating antibiotic therapy, suggesting that children with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare 2.
- Another study published in Anales de pediatria compared the effectiveness and safety of a shortened 5- to 7-day antibiotic regimen with the classic 10-day regimen for acute streptococcal pharyngotonsillitis, but did not provide specific guidance on the duration of stay at home after starting antibiotics 3.
Antibiotic Regimens and Duration of Therapy
- The choice of antibiotic regimen and duration of therapy may affect the duration of stay at home, with some studies suggesting that shorter courses of antibiotic therapy may be effective for acute streptococcal pharyngitis 3, 4.
- A study published in Clinical infectious diseases found that 10 days of clarithromycin therapy was more effective than 5 days of azithromycin therapy in eradicating group A streptococci from the throats of individuals with symptomatic pharyngitis 5.
- However, the duration of stay at home after starting antibiotics is not directly related to the choice of antibiotic regimen, but rather to the risk of transmission to close contacts and the patient's clinical condition 2.
Clinical Considerations
- The decision to return to school or daycare after starting antibiotics for streptococcal pharyngitis should be based on the patient's clinical condition, including the absence of fever and improvement of symptoms, rather than solely on the duration of antibiotic therapy 2, 6.
- Patients with streptococcal pharyngitis should be advised to stay home from school or daycare for at least 24 hours after starting antibiotics, and to practice good hygiene, such as frequent handwashing and covering the mouth and nose when coughing or sneezing, to reduce the risk of transmission to close contacts 2.