What is the recommended intramuscular (IM) treatment for streptococcal infections, such as strep throat?

From the Guidelines

The recommended intramuscular (IM) treatment for streptococcal infections, including strep throat, is a single dose of benzathine penicillin G, with a dose of 600,000 units for children weighing less than 27 kg and 1,200,000 units for individuals weighing 27 kg or more, as supported by the Infectious Diseases Society of America guidelines 1. This treatment is particularly valuable for patients with poor medication adherence or those who cannot tolerate oral antibiotics. The injection should be administered in a large muscle, typically the gluteal muscle in adults or the anterolateral thigh in children. Some key points to consider when administering benzathine penicillin G include:

• The dose and administration route are crucial for effective treatment, with a single IM dose being sufficient for most patients.
• The treatment is effective in preventing complications like rheumatic fever and post-streptococcal glomerulonephritis, as noted in the guidelines 1.
• For patients with penicillin allergies, alternative treatments include oral macrolides such as azithromycin or clindamycin, though these would require a different administration route and dosing schedule, as discussed in the guidelines 1. It's essential to follow the recommended guidelines for the diagnosis and management of group A streptococcal pharyngitis to ensure effective treatment and prevent potential complications.

From the FDA Drug Label

When treating infections caused by Streptococcus pyogenes, therapy should be continued for at least 10 days. The usual adult daily dose is 1 to 2 grams given once a day (or in equally divided doses twice a day) depending on the type and severity of infection. For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses twice a day). Intramuscular penicillin G benzathine is indicated in the treatment of infections due to penicillin-G-sensitive microorganisms that are susceptible to the low and very prolonged serum levels common to this particular dosage form. Mild-to-moderate infections of the upper-respiratory tract due to susceptible streptococci.

The recommended intramuscular (IM) treatment for streptococcal infections, such as strep throat, is:

• Ceftriaxone (IM): 1 to 2 grams given once a day (or in equally divided doses twice a day) depending on the type and severity of infection, for at least 10 days 2.
• Benzathine penicillin G (IM): used to treat mild-to-moderate infections of the upper-respiratory tract due to susceptible streptococci 3. Key points:
• The dosage and duration of therapy may vary depending on the severity of the infection and the patient's response to treatment.
• It is essential to follow the recommended dosage and administration guidelines to ensure effective treatment and minimize the risk of adverse reactions.

From the Research

Strep Treatment by Intramuscular Shot

• The recommended intramuscular (IM) treatment for streptococcal infections, such as strep throat, is penicillin G benzathine 4, 5.
• A single injection of intramuscular penicillin G benzathine, alone or in combination with penicillin G procaine, was the preferred treatment in the past 4.
• Studies have shown that intramuscular penicillin G benzathine is more effective than oral penicillin in reducing RF recurrence and streptococcal throat infections 6.
• The dosage of intramuscular penicillin G benzathine can vary, but 600,000 to 1.2 million units is commonly used 5.
• Intramuscular penicillin G benzathine is particularly useful in areas where rheumatic fever is still prevalent, and compliance with oral penicillin cannot be relied on 4.
• Other studies have compared intramuscular penicillin G benzathine with oral amoxicillin, and found that amoxicillin may be a suitable alternative in some cases 7.
• However, if compliance is a major issue, a single dose of intramuscular penicillin G benzathine may be preferable for treatment of GAS pharyngitis 7.

Dosage and Administration

• The dosage of intramuscular penicillin G benzathine can vary, but common dosages include:
  • 600,000 units of penicillin G benzathine 5
  • 1.2 million units of penicillin G benzathine 5
  • 900,000 units of penicillin G benzathine and 300,000 units of penicillin G procaine 5
• The injection is typically given intramuscularly, and the frequency of administration can vary depending on the specific treatment regimen 6.

Comparison with Other Treatments

• Intramuscular penicillin G benzathine has been compared with oral penicillin, and found to be more effective in reducing RF recurrence and streptococcal throat infections 6.
• Intramuscular penicillin G benzathine has also been compared with oral amoxicillin, and found to be comparable in some cases 7.
• Other antibiotics, such as erythromycin and clindamycin, may also be effective in treating streptococcal infections, but intramuscular penicillin G benzathine is often preferred due to its high cure rates and compliance advantages 8.