What is the recommended treatment for strep throat?

From the Guidelines

The recommended treatment for strep throat is antibiotics, specifically penicillin or amoxicillin as first-line therapy. For adults, the typical regimen is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days 1. For children, the dosage is weight-based, usually 250-500 mg of amoxicillin twice daily for 10 days. For patients with penicillin allergy, alternatives include cephalexin (if no anaphylactic reaction history), or macrolides such as azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) 1.

Key Considerations

• It's crucial to complete the full course of antibiotics even if symptoms improve before finishing the prescription.
• 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 important because they reduce symptom duration, decrease contagiousness (patients are typically no longer contagious after 24 hours of antibiotic therapy), and prevent serious complications like rheumatic fever, kidney inflammation, and abscess formation 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.

Additional Guidance

• The use of antibiotics should be guided by a confirmed diagnosis of group A streptococcal pharyngitis, ideally through rapid antigen detection test and/or culture for group A Streptococcus 1.
• Clinicians should weigh the benefits of antibiotics against potential side effects, the impact on microbiota, and the risk of antibacterial resistance, especially in patients with less severe presentations of sore throat 1.

From the FDA Drug Label

Amoxicillin is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus species. (α- and β-hemolytic isolates only), It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever.

The recommended treatment for strep throat is amoxicillin for at least 10 days to prevent the occurrence of acute rheumatic fever 2.

• The dosage for adults and pediatric patients aged 3 months (12 weeks and older) is as follows:
  • Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours for patients weighing more than 40 kg, and 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for patients weighing less than 40 kg.
  • Severe: 875 mg every 12 hours or 500 mg every 8 hours for patients weighing more than 40 kg, and 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for patients weighing less than 40 kg.

From the Research

Treatment Options for Strep Throat

The recommended treatment for strep throat typically involves antibiotics to help alleviate symptoms and prevent complications. Some of the commonly used antibiotics include:

• Penicillin: administered for 10 days, it has been the traditional treatment of choice for group A beta-hemolytic streptococcal tonsillopharyngitis 3
• Cephalosporins: have been shown to be superior to penicillin in eradicating group A beta-hemolytic Streptococcus and can be effective when administered for 4 to 5 days 3
• Macrolides: such as clarithromycin and azithromycin, offer a convenient dosing schedule and lower rates of gastrointestinal side effects, making them suitable alternatives for patients allergic to penicillin 4

Efficacy of Different Antibiotics

Studies have compared the efficacy of different antibiotics in treating strep throat:

• Clarithromycin suspension vs penicillin V suspension: clarithromycin produced comparable rates of clinical success and a significantly higher GABHS eradication rate 5
• Azithromycin vs penicillin V: azithromycin was found to be a safe and effective alternative treatment for streptococcal pharyngitis, with a high eradication rate of GABHS 6
• Clarithromycin, amoxicillin/clavulanate, and penicillin V: all regimens had similar clinical efficacy, but amoxicillin/clavulanate and penicillin V were more effective in eradicating S. pyogenes, particularly in areas with high clarithromycin resistance 7

Considerations for Treatment

When choosing an antibiotic for strep throat, considerations should include:

• Patient allergy history: alternative antibiotics such as macrolides may be necessary for patients allergic to penicillin 4
• Antibiotic resistance: the prevalence of resistant strains in the area should be taken into account when selecting an antibiotic 7
• Treatment duration and compliance: shorter treatment courses, such as 4 to 5 days, may improve compliance and reduce the risk of treatment failure 3