What is the recommended treatment for a 23-year-old woman who is 7 weeks pregnant and diagnosed with streptococcal pharyngitis (strep throat)?

From the Guidelines

For a 23-year-old woman who is 7 weeks pregnant with streptococcal pharyngitis, the recommended treatment is penicillin, specifically penicillin V 500 mg orally twice daily for 10 days, as it is considered safe during all trimesters of pregnancy and has no known harmful effects on the developing fetus 1. The treatment of streptococcal pharyngitis during pregnancy is crucial to prevent complications such as rheumatic fever and potential adverse pregnancy outcomes.

• Penicillin V is the first-line therapy for streptococcal pharyngitis in pregnant women, with a recommended dosage of 500 mg orally twice daily for 10 days 1.
• If the patient has a penicillin allergy, cephalexin 500 mg orally twice daily for 10 days can be used if it's not a severe allergy, as cephalexin is a suitable alternative for patients with non-severe penicillin allergies 1.
• For those with severe penicillin allergies, azithromycin 500 mg on day 1 followed by 250 mg daily for 4 more days is an appropriate alternative, as it is effective against streptococcal pharyngitis and considered safe during pregnancy 1. It is essential to complete the entire course of antibiotics, even if symptoms improve before finishing the medication, to ensure the infection is fully cleared and to prevent potential complications. Symptomatic relief can include acetaminophen for pain and fever, warm salt water gargles, and adequate hydration. The patient should follow up if symptoms worsen or don't improve within 48-72 hours of starting antibiotics. Penicillin is the preferred choice due to its safety profile and effectiveness, as supported by the Infectious Diseases Society of America guidelines 1.

From the FDA Drug Label

Penicillin is considered by the American Heart Association to be the drug of choice in the prevention of initial attacks of rheumatic fever (treatment of Streptococcus pyogenes infections of the upper respiratory tract e.g., tonsillitis, or pharyngitis). Erythromycin tablets are indicated for the treatment of penicillin-allergic patients. The therapeutic dose should be administered for ten days.

The recommended treatment for a 23-year-old woman who is 7 weeks pregnant and diagnosed with streptococcal pharyngitis (strep throat) is penicillin, as it is the drug of choice according to the American Heart Association. However, if the patient is allergic to penicillin, erythromycin is an alternative option. The therapeutic dose of erythromycin should be administered for at least ten days 2.

From the Research

Treatment Options for Strep Throat in Pregnancy

The recommended treatment for a 23-year-old woman who is 7 weeks pregnant and diagnosed with streptococcal pharyngitis (strep throat) depends on various factors, including the severity of the infection and the patient's medical history.

• Penicillin V for 10 days is the standard therapy and is effective in the management of GABHS pharyngitis 3.
• However, there are drawbacks to penicillin V therapy, including the length of the dosing regimen, which can lead to decreasing penicillin prescription rates in many countries 3.
• Azithromycin is an alternative treatment option, with a total dose of 60 mg/kg given over 3 or 5 days, which provides a high rate of GABHS eradication 3, 4.
• Erythromycin is also an effective antibiotic for the treatment of streptococcal pharyngitis, with a daily dosage of 20 to 30 mg/kg/day for erythromycin estolate and 40 mg/kg/day for erythromycin ethylsuccinate 5.

Safety of Medications during Pregnancy

• The use of Kalgaron or Strepsils lozenges during pregnancy was not associated with an increased risk of malformations, spontaneous abortions, or decreased birthweight 6.
• However, larger studies are needed to confirm the safety of these medications during pregnancy 6.
• Azithromycin and erythromycin have been shown to be safe and effective in the treatment of streptococcal pharyngitis in non-pregnant patients 3, 5, 4, but their safety during pregnancy should be carefully evaluated.

Considerations for Treatment

• The choice of treatment should be based on the patient's medical history, the severity of the infection, and the potential risks and benefits of each medication 3, 7.
• Patient compliance with the treatment regimen is crucial to ensure effective eradication of the infection 3, 7.
• The treatment should be given for the recommended duration, usually 10 days for penicillin V and 3 to 5 days for azithromycin 3, 4.