From the Guidelines
The first-line treatment for strep throat is oral penicillin V (phenoxymethylpenicillin), typically prescribed as 250 mg twice daily for children or 500 mg twice daily for adults, for a 10-day course. Alternatively, amoxicillin 50 mg/kg once daily (maximum 1000 mg) for children or 1000 mg once daily for adults for 10 days is equally effective and may be preferred due to better taste and once-daily dosing options. For patients with penicillin allergy, azithromycin (12 mg/kg once daily for 5 days, maximum 500 mg) or first-generation cephalosporins like cephalexin (if no history of anaphylaxis to penicillin) are appropriate alternatives. Complete the entire antibiotic course even if symptoms improve to prevent complications such as rheumatic fever and post-streptococcal glomerulonephritis. Penicillin remains the first choice because Group A Streptococcus (the bacteria causing strep throat) has not developed resistance to it, and it has a narrow spectrum that minimizes disruption to normal gut flora, as supported by studies such as 1. Symptomatic relief with acetaminophen or ibuprofen, warm salt water gargles, and adequate hydration is also recommended while waiting for antibiotics to take effect.
Some key points to consider when treating strep throat include:
- The importance of completing the full antibiotic course to prevent complications
- The use of penicillin as the first-line treatment due to its efficacy, safety, and narrow spectrum
- The consideration of alternative treatments, such as azithromycin or first-generation cephalosporins, for patients with penicillin allergy
- The role of symptomatic relief measures, such as pain management and hydration, in addition to antibiotic treatment, as discussed in studies like 1 and 1.
It's also important to note that while other antibiotics, such as cephalosporins, may be effective in treating strep throat, penicillin remains the preferred choice due to its long history of use and proven track record, as highlighted in studies like 1. Additionally, the use of rapid streptococcal antigen tests can be helpful in diagnosing strep throat, but they should be used in conjunction with clinical assessment and not relied upon as the sole means of diagnosis.
From the FDA Drug Label
Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. The first-line treatment for strep throat is Penicillin. 2
From the Research
First-Line Treatment for Strep Throat
The first-line treatment for strep throat typically involves the use of antibiotics to eradicate the causative bacteria, Streptococcus pyogenes. The choice of antibiotic may depend on various factors, including patient age, allergy history, and local resistance patterns.
Antibiotic Options
- Penicillin is often considered the drug of choice for strep throat, particularly for patients who are not allergic to it 3, 4.
- For patients allergic to penicillin, macrolide antibiotics such as azithromycin or clarithromycin may be used as alternatives 5, 3, 6, 7.
- Azithromycin is typically administered for 5 days, while clarithromycin is administered for 10 days 5, 7.
- Cephalosporins may also be effective in eradicating group A beta-hemolytic Streptococcus, particularly when administered for 4 to 5 days 4.
Efficacy and Safety
- Studies have shown that azithromycin and clarithromycin are effective in treating strep throat, although clarithromycin may be more effective in eradicating the bacteria 7.
- Penicillin has been shown to be effective in treating strep throat, but its use may be limited by increasing rates of bacteriologic failure 4.
- Azithromycin and clarithromycin have been shown to be well-tolerated, with mild to moderate gastrointestinal side effects being the most common adverse events 5, 6.
Treatment Duration
- The duration of treatment for strep throat typically ranges from 5 to 10 days, depending on the antibiotic used 5, 4, 7.
- Shortened courses of antibiotic therapy, such as 5 days of azithromycin, may be effective in treating strep throat, but may not be as effective in eradicating the bacteria as longer courses of therapy 7.