What is the recommended treatment for strep throat?

From the Guidelines

The recommended treatment for strep throat is antibiotics, specifically penicillin or amoxicillin, as they have been shown to be effective in reducing symptom duration, preventing complications, and decreasing contagiousness. For adults, the standard regimen is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days, as recommended by the Infectious Diseases Society of America 1. For children, dosing is weight-based, usually amoxicillin 50 mg/kg/day divided into two or three doses for 10 days.

Key Considerations

• For patients with penicillin allergy, alternatives include cephalexin (if no anaphylactic reaction history), or macrolides like azithromycin (12 mg/kg once daily, max 500 mg, for 5 days) 1.
• It's essential to complete the full course of antibiotics even if symptoms improve within a few days.
• Alongside antibiotics, supportive care includes rest, adequate hydration, over-the-counter pain relievers like acetaminophen or ibuprofen for fever and throat pain, and warm salt water gargles.
• Antibiotics are crucial because they reduce symptom duration, prevent complications like rheumatic fever or kidney inflammation, and decrease contagiousness within 24 hours of starting treatment, as highlighted in the 2012 update by the Infectious Diseases Society of America 1.
• Patients should stay home from work or school until they've been on antibiotics for at least 24 hours and no longer have fever.

Evidence-Based Recommendations

The evidence from the Infectious Diseases Society of America 1 and other studies 1 supports the use of penicillin or amoxicillin as the first-line treatment for strep throat. While other antibiotics like cephalosporins and macrolides may be effective, penicillin and amoxicillin are preferred due to their proven efficacy, safety, narrow spectrum, and low cost.

Clinical Practice Guidelines

The clinical practice guidelines for the diagnosis and management of group A streptococcal pharyngitis, as outlined in the 2012 update by the Infectious Diseases Society of America 1, emphasize the importance of accurate diagnosis and appropriate antimicrobial therapy to prevent complications and reduce transmission. The guidelines recommend penicillin or amoxicillin as the first-line treatment, with alternatives for patients with penicillin allergy.

Patient Care

Patient care should prioritize completing the full course of antibiotics, even if symptoms improve within a few days, and staying home from work or school until they've been on antibiotics for at least 24 hours and no longer have fever. Supportive care, including rest, hydration, and over-the-counter pain relievers, can help manage symptoms and improve quality of life.

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 recommended treatment for strep throat is penicillin for a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease 2. Azithromycin can be used as an alternative to first-line therapy in individuals who cannot use first-line therapy 3. Key points to consider:

• The treatment should be sufficient to eliminate the organism
• The minimum duration of therapy is 10 days
• Penicillin is the usual drug of choice for the treatment of Streptococcus pyogenes infection
• Azithromycin can be used as an alternative in individuals who cannot use first-line therapy

From the Research

Treatment Options for Strep Throat

• The primary goal of treatment for strep throat is to prevent acute rheumatic fever, relieve symptoms, shorten the infective period, and prevent suppurative complications 4.
• Penicillin is the drug of choice for treating strep throat, but alternatives are needed for patients allergic to penicillin 4.
• Macrolides such as clarithromycin and azithromycin are rational alternatives to erythromycin for streptococcal pharyngitis/tonsillitis in penicillin-allergic patients 4.
• Azithromycin has been shown to be a safe and effective alternative treatment for streptococcal pharyngitis, with a recommended duration of 5 days 5.
• Clarithromycin has also been found to be as safe and effective as penicillin V in the treatment of Streptococcus pyogenes throat infections 6.

Antibiotic Recommendations

• Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days 7.
• First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 7.
• Azithromycin and clarithromycin are not recommended due to significant resistance in some parts of the United States 7.

Diagnosis and Treatment Approach

• Clinical decision rules should be used to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear 7.
• A throat culture is recommended in children and adolescents after a negative rapid antigen test result 7.
• Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 7.