From the Guidelines
Streptococcal throat infections are primarily treated with antibiotics, with penicillin being the first-line treatment, as recommended by the most recent guidelines 1.
Treatment Overview
The treatment for streptococcal throat infections typically involves antibiotics to prevent complications and reduce the duration of symptoms.
- For adults, the recommended regimen is penicillin V 500 mg orally twice daily for 10 days, or a single intramuscular injection of benzathine penicillin G 1.2 million units for patients who may not complete the oral course.
- For penicillin-allergic patients, alternatives include cephalexin 500 mg twice daily for 10 days (if not severely allergic), or macrolides such as azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days.
Supportive Care
Completing the full antibiotic course is essential even if symptoms improve quickly, as this prevents complications like rheumatic fever and kidney inflammation.
- Supportive care is also important, including 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 are no longer contagious.
Reevaluation
If symptoms worsen or don't improve after 48 hours of antibiotic treatment, medical reevaluation is necessary, as indicated by recent studies 1.
- The most recent guidelines emphasize the importance of testing patients with symptoms suggestive of group A streptococcal pharyngitis and treating only those with confirmed infections 1.
From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (10-day minimum); otherwise the sequelae of streptococcal disease may occur. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.
The treatment for streptococcal (strep) throat is typically penicillin for a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease. Azithromycin can be used as an alternative in individuals who cannot use first-line therapy 2, 3, 3.
From the Research
Treatment Options for Strep Throat
- The treatment for streptococcal (strep) throat typically involves antibiotics, with the goal of eradicating the bacteria and reducing the risk of complications 4, 5.
- Penicillin has been the traditional treatment of choice for strep throat, but its effectiveness can be limited by factors such as lack of compliance, reexposure to infected individuals, and antibiotic tolerance 5.
- Alternative antibiotics, such as azithromycin, have been shown to be effective in treating strep throat, with the advantage of shorter treatment courses and improved compliance 4.
- Cephalosporins have also been demonstrated to be superior to penicillin in eradicating group A beta-hemolytic Streptococcus, and can be effective when administered for 4 to 5 days 5.
Dosage and Administration
- The optimal dosing interval for penicillin treatment of strep throat has been studied, with results suggesting that twice-daily dosing is more effective than once-daily dosing 6.
- Once-daily amoxicillin has been shown to be effective in treating strep throat, with the advantage of improved compliance and lower cost 7.
- Other antibiotics, such as azithromycin and extended-release amoxicillin, can also be effective when dosed once daily, but may be more expensive than conventional amoxicillin 7.
Clinical Considerations
- The choice of antibiotic and dosing regimen should be based on individual patient factors, such as age, weight, and medical history 8, 6.
- Clinicians should also consider the potential for antibiotic resistance and the importance of completing the full treatment course to ensure effective eradication of the bacteria 4, 5.