What about amoxicillin for strep throat treatment?

From the Guidelines

Amoxicillin is a highly effective first-line treatment for strep throat (streptococcal pharyngitis), with a recommended dosage of 50 mg/kg once daily (max = 1000 mg) for 10 days, as supported by strong, high-quality evidence 1.

Key Points to Consider

• The typical adult dose is 500 mg twice daily or 250 mg three times daily for 10 days.
• For children, the dosage is usually 40-50 mg/kg/day divided into two or three doses for 10 days.
• It's crucial to complete the full course of antibiotics even if symptoms improve before finishing the medication to ensure complete eradication of the bacteria and prevent complications like rheumatic fever or kidney inflammation.
• Amoxicillin is effective because it targets the Group A Streptococcus bacteria by disrupting their cell wall synthesis.
• The medication is generally well-tolerated, though some patients may experience side effects like diarrhea, nausea, or rash.
• If you have a penicillin allergy, alternative antibiotics like azithromycin or clindamycin should be used instead, as recommended by guidelines 1.

Additional Considerations

• Staying hydrated, using throat lozenges, and taking over-the-counter pain relievers can help manage symptoms while the antibiotic works to clear the infection.
• The choice of antibiotic should consider factors such as efficacy, safety, antimicrobial spectrum, dosing schedule, and cost, as outlined in guidelines 1.
• Penicillin-resistant Group A Streptococcus has never been documented, making penicillin and its congeners, including amoxicillin, reliable treatment options 1.

From the FDA Drug Label

Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat: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),

• Amoxicillin is indicated for the treatment of strep throat caused by susceptible Streptococcus species.
• The 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

Amoxicillin for Strep Throat Treatment

• Amoxicillin is an effective treatment for strep throat, with studies showing its efficacy in eradicating group A streptococcal (GAS) infections 3, 4, 5.
• The dosage regimen for amoxicillin in treating strep throat can vary, with once-daily, twice-daily, and three-times-daily regimens being compared in different studies 3, 4, 5.
• Research suggests that once-daily amoxicillin is not inferior to twice-daily amoxicillin in treating GAS pharyngitis, with similar bacteriologic failure rates and adverse event frequencies 3.
• A study using real-time PCR to compare the effectiveness of once-daily and multiple-daily amoxicillin treatment for pediatric patients with GAS pharyngitis found no statistical difference in negative results and median value of GAS copies between regimens 4.
• Another study demonstrated that once-daily amoxicillin therapy is as effective as penicillin V therapy given three times a day for the treatment of GAS pharyngitis, with no significant difference in clinical or bacteriologic responses 5.

Comparison with Other Antibiotics

• Azithromycin has been compared to amoxicillin in the treatment of streptococcal pharyngitis, with azithromycin appearing to be a safe and effective alternative treatment 6, 7.
• However, azithromycin may result in more recurrence of infection than penicillin V, necessitating a higher dosage or longer treatment duration 6, 7.

Treatment Outcomes

• The effectiveness of amoxicillin in treating strep throat is measured by its ability to eradicate GAS infections, with treatment outcomes including clinical cure, bacteriologic eradication, and prevention of recurrence 3, 4, 5.
• Adverse events, such as gastrointestinal complaints, are also monitored and compared between different treatment regimens 3, 7, 5.