What is the recommended treatment for adult strep throat?

From the Guidelines

The recommended treatment for adult strep throat is penicillin, specifically penicillin V (phenoxymethylpenicillin) 500 mg orally twice daily for 10 days, or a one-time intramuscular injection of penicillin G benzathine 1.2 million units if oral compliance is a concern. This recommendation is based on the strongest and most recent evidence from the Infectious Diseases Society of America (IDSA) guidelines 1. For patients with penicillin allergy, alternatives include amoxicillin 500 mg three times daily for 10 days, or for those with true penicillin allergy, azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days, or clindamycin 300 mg three times daily for 10 days.

Key Considerations

• Completing the full course of antibiotics is crucial, even if symptoms improve before finishing the medication.
• Supportive care with over-the-counter pain relievers like acetaminophen or ibuprofen, warm salt water gargles, and adequate hydration can help manage symptoms while the antibiotics work.
• Antibiotics are essential for treating strep throat as they reduce symptom duration, prevent complications like rheumatic fever or kidney inflammation, and decrease contagiousness within 24 hours of starting treatment.
• 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 IDSA guidelines 1 provide strong, high-quality evidence for the recommended antibiotic regimens. Additionally, the American College of Physicians and the Centers for Disease Control and Prevention recommend antibiotic therapy only for patients with a positive streptococcal test result 1. The European Society for Clinical Microbiology and Infectious Diseases also recommends penicillin V as the first choice in patients with acute sore throat 1.

Patient Care

It's essential to weigh the benefits of antibiotics against side effects, the effect on microbiota, increased antibacterial resistance, medicalization, and costs. Patients with less severe presentations of sore throat (0-2 Centor criteria) should not be treated with antibiotics to relieve symptoms. However, in patients with more severe presentations (3-4 Centor criteria), physicians should consider discussing the likely benefits with patients.

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), 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 adult strep throat is amoxicillin or azithromycin as an alternative to first-line therapy, for the treatment of infections due to susceptible isolates of Streptococcus species, including Streptococcus pyogenes 2 3.

• Amoxicillin is indicated for the treatment of upper respiratory tract infections, including strep throat, caused by susceptible strains of Streptococcus species.
• Azithromycin is indicated as an alternative to first-line therapy for the treatment of pharyngitis/tonsillitis caused by Streptococcus pyogenes.

From the Research

Adult Strep Throat Treatment

The recommended treatment for adult strep throat typically involves antibiotics to eradicate the bacterial cause, Group A streptococci (GABHS), and prevent complications such as rheumatic fever or suppurative disease.

• Penicillin V is considered the standard therapy for GABHS pharyngitis, administered for 10 days 4.
• Amoxicillin has also been shown to be effective in treating streptococcal tonsillitis in adults, with a 6-day course of amoxicillin 1 g twice daily being comparable to a 10-day course of penicillin V 1 million units three times daily in terms of GABHS eradication and clinical success rates 5.
• For patients allergic to penicillin or with suspected non-adherence to a 10-day penicillin regimen, macrolide antibiotics such as azithromycin or clarithromycin can be used as alternatives 4, 6.
• Azithromycin has been studied in various dosing regimens, with higher dosages (e.g., 60 mg/kg per course in children or 500 mg/day for 3 days in adults) showing greater effectiveness in treating GABHS tonsillopharyngitis compared to lower dosages or shorter treatment durations 7, 8.
• The choice of antibiotic and treatment duration should be based on the patient's specific needs, potential allergies, and the likelihood of adherence to the prescribed regimen.

Considerations for Treatment

When selecting a treatment for adult strep throat, it's essential to consider the following:

• The patient's medical history, including any allergies to antibiotics.
• The severity of symptoms and the presence of any complications.
• The potential for antibiotic resistance and the need for susceptibility testing.
• The importance of completing the full treatment course to ensure eradication of the bacteria and prevent recurrence or spread of the infection.