From the Guidelines
For a patient with a positive throat swab for Group A Streptococcus (GAS) who has already been prescribed Augmentin, the recommended next step is to switch to phenoxymethylpenicillin (penicillin V) as first-line therapy, as it is the most recent and highest quality recommendation for treating strep throat in New Zealand general practice. The typical adult dose is 500 mg twice daily for 10 days, while children should receive 10 mg/kg/dose twice daily (maximum 500 mg per dose) for 10 days 1. Augmentin is unnecessarily broad-spectrum for strep throat and should be reserved for more complex infections. If the patient has a penicillin allergy, appropriate alternatives include erythromycin (400 mg twice daily for 10 days) or roxithromycin (300 mg once daily for 10 days) 1. Some key points to consider in the management of strep throat include:
- Completing the full course of antibiotics even if symptoms improve quickly to prevent complications like rheumatic fever 1
- Advising the patient that they are no longer infectious after 24 hours of antibiotic treatment and can return to normal activities 1
- Recommending symptomatic relief with paracetamol or ibuprofen and adequate hydration 1
- Being aware that streptococcal carriers do not ordinarily require further antimicrobial therapy and are unlikely to spread the organism to their close contacts or develop suppurative or nonsuppurative complications 1. Penicillin V is preferred because it specifically targets GAS without disrupting the normal gut flora, which reduces side effects like diarrhea and decreases the risk of antimicrobial resistance.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps in Management
- The patient has already been prescribed Augmentin (amoxicillin/clavulanic acid) on first presentation, which is an appropriate antibiotic for treating streptococcal pharyngitis 2, 3.
- The recommended duration of antibiotic treatment for streptococcal pharyngitis is typically 10 days 2, 3, but some studies suggest that shorter courses of 5-7 days may be effective and safe 4.
- It is essential to ensure the patient completes the full course of antibiotic treatment as prescribed to prevent treatment failures and reduce the risk of complications such as acute rheumatic fever 2, 3.
- The patient should be advised to return for a follow-up visit if symptoms persist or worsen, or if they experience any adverse effects from the antibiotic treatment 5, 6.
- It is also important to consider the patient's adherence to the antibiotic regimen and provide guidance on how to take the medication correctly to maximize its effectiveness 3, 6.
Considerations for Antibiotic Treatment
- Amoxicillin/clavulanic acid (Augmentin) is a suitable antibiotic for treating streptococcal pharyngitis, but other options such as penicillin V or cephalosporins may also be considered 2, 3.
- The choice of antibiotic should be based on factors such as the patient's allergy history, medication tolerance, and the likelihood of antibiotic resistance in the community 2, 6.
- It is crucial to use antibiotics judiciously and only when necessary to minimize the risk of antibiotic resistance and promote responsible use of these medications 6.