What is the recommended treatment and dosing for strep throat in adults?

From the Guidelines

The recommended treatment for strep throat in adults is penicillin V potassium (250-500 mg orally twice daily for 10 days) or amoxicillin (500 mg orally twice daily or 1000 mg once daily for 10 days). For patients with penicillin allergy, alternatives include cephalexin (500 mg orally twice daily for 10 days), azithromycin (500 mg on day 1, then 250 mg daily for 4 more days), or clindamycin (300 mg orally three times daily for 10 days) 1. The full 10-day course should be completed even if symptoms improve earlier to ensure complete eradication of Group A Streptococcus bacteria and prevent complications like rheumatic fever.

Symptomatic relief can be achieved with:

• Acetaminophen or ibuprofen for pain and fever
• Warm salt water gargles
• Adequate hydration Patients should rest and stay home from work or school for at least 24 hours after starting antibiotics, as they are no longer contagious at this point. Penicillins remain the first-line treatment because they are narrow-spectrum antibiotics with excellent efficacy against strep throat, and Group A Streptococcus has not developed resistance to them despite decades of use 1.

It is essential to note that antibiotics should only be prescribed if the diagnosis of strep throat is confirmed by a rapid antigen detection test and/or culture for group A Streptococcus, as recommended by the American College of Physicians and the Centers for Disease Control and Prevention 1. This approach helps prevent unnecessary antibiotic use and reduces the risk of antibiotic resistance.

In terms of prevention, early initiation of antimicrobial therapy can result in faster resolution of signs and symptoms, but it is crucial to remember that group A streptococcal pharyngitis is usually a self-limited disease, and therapy can be safely postponed for up to 9 days after the onset of symptoms and still prevent the occurrence of acute rheumatic fever 1.

Overall, the treatment of strep throat in adults should prioritize the use of penicillin or amoxicillin, with alternative options available for patients with penicillin allergy, and emphasize the importance of completing the full 10-day course of antibiotics to prevent complications and reduce the risk of antibiotic resistance.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and other antibacterial drugs, amoxicillin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. 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 For Streptococcal infections, the usual dosage recommendations for adults are as follows:

• 500 mg every 12 hours or 250 mg every 8 hours
• 875 mg every 12 hours or 500 mg every 8 hours for more severe infections

  For penicillin V, the usual dosage recommendations for adults are as follows:

• 125 mg to 250 mg (200,000 to 400,000 units) every 6 to 8 hours for 10 days for Streptococcal infections - mild to moderately severe - of the upper respiratory tract

  For benzathine penicillin G, the recommended dosage for adults with Streptococcal (Group A) Upper Respiratory Infections is a single injection of 1,200,000 units.

The recommended treatment for strep throat in adults is amoxicillin or penicillin.

• The dosing instructions for amoxicillin are:
  • 500 mg every 12 hours or 250 mg every 8 hours
  • 875 mg every 12 hours or 500 mg every 8 hours for more severe infections
• The dosing instructions for penicillin V are:
  • 125 mg to 250 mg (200,000 to 400,000 units) every 6 to 8 hours for 10 days
• The dosing instructions for benzathine penicillin G are:
  • a single injection of 1,200,000 units. Treatment should be continued for at least 10 days to prevent the occurrence of acute rheumatic fever, and 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, 3, 4.

From the Research

Strep Throat Treatment in Adults

The recommended treatment for strep throat in adults typically involves antibiotics to reduce the duration and severity of symptoms, as well as to prevent complications such as rheumatic fever.

Antibiotic Options

• Penicillin: Penicillin V is commonly prescribed, with a typical dosage of 250 mg taken every 6 hours for 10 days 5.
• Amoxicillin: Amoxicillin can be an alternative, with studies suggesting that a 6-day course of amoxicillin 1 g twice daily is as effective as a 10-day course of penicillin V 1 MU three times daily for the treatment of streptococcal tonsillitis in adults 6.
• Azithromycin: Azithromycin is another option, with a study indicating that azithromycin 500 mg once on day 1 followed by 250 mg once daily for 4 days is effective in treating streptococcal pharyngitis in adults 7.
• Clarithromycin: Clarithromycin has also been shown to be effective, with a dosage of 250 mg twice daily comparable to penicillin VK 250 mg three times daily in treating streptococcal pharyngitis 8.

Dosing Frequency

• A meta-analysis suggests that twice-daily dosing of 10-day penicillin is as efficacious as more frequent dosing regimens in the treatment of streptococcal tonsillopharyngitis 9.
• Once-daily dosing of penicillin is associated with a lower cure rate compared to more frequent dosing, but this does not apply to amoxicillin 9.

Considerations

• The choice of antibiotic and dosing regimen should be based on factors such as patient tolerance, potential side effects, and the presence of any underlying medical conditions.
• It is essential to complete the full course of antibiotic treatment as prescribed to ensure effective eradication of the infection and prevent the development of antibiotic resistance.