From the Guidelines
Pharyngitis treatment should be guided by whether the cause is viral or bacterial, with antibiotics necessary for bacterial pharyngitis, particularly Group A Streptococcus, and symptom relief measures for viral pharyngitis. For viral pharyngitis, which accounts for about 80% of cases, treatment focuses on symptom relief with rest, increased fluid intake, saltwater gargles, and over-the-counter pain relievers like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours) 1. For bacterial pharyngitis, first-line treatment is penicillin V (250-500mg orally twice daily for 10 days) or amoxicillin (500mg twice daily for 10 days), as these have a narrow spectrum of activity, infrequency of adverse reactions, and modest cost 1, 2.
Key Considerations for Bacterial Pharyngitis Treatment
- Penicillin or amoxicillin is the recommended drug of choice for those non-allergic to these agents, due to their efficacy, safety, and cost-effectiveness 1, 2.
- For penicillin-allergic patients, alternatives include a first-generation cephalosporin (for those not anaphylactically sensitive) for 10 days, clindamycin or clarithromycin for 10 days, or azithromycin for 5 days 1, 3, 2.
- Treating strep throat with antibiotics reduces symptom duration, prevents complications like rheumatic fever and peritonsillar abscess, and decreases transmission 4.
- Patients should complete the full antibiotic course even if symptoms improve quickly, and can return to normal activities 24 hours after starting antibiotics when they're no longer contagious.
Additional Treatment Options
- Azithromycin (500mg on day 1, then 250mg daily for 4 days) or clindamycin (300mg three times daily for 10 days) may be used in penicillin-allergic patients, with consideration of resistance patterns and side effect profiles 4.
- Cephalexin may be used if there is no history of anaphylactic reaction to penicillin, but broad-spectrum cephalosporins are generally not recommended due to their higher cost and potential for selecting antibiotic-resistant flora 4.
From the FDA Drug Label
In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes) Azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates (for the combined evaluable patient with documented GABHS): Three U. S. Streptococcal Pharyngitis Studies Azithromycin vs. Penicillin V EFFICACY RESULTS Day 14 Day 30 Bacteriologic Eradication: Azithromycin 323/340 (95%) 255/330 (77%) Penicillin V 242/332 (73%) 206/325 (63%) Clinical Success (Cure plus improvement): Azithromycin 336/343 (98%) 310/330 (94%) Penicillin V 284/338 (84%) 241/325 (74%)
The treatment for pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes) is azithromycin (12 mg/kg once a day for 5 days) or penicillin V (250 mg three times a day for 10 days). Azithromycin has been shown to be clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 5.
From the Research
Treatment Options for Pharyngitis
- The primary treatment for pharyngitis caused by group A beta-hemolytic streptococci (GABHS) is antibiotics, with the goal of eradicating the pathogen, limiting the spread of infection, and preventing potential complications such as rheumatic fever 6, 7, 8.
- Penicillin V is the standard therapy for GABHS pharyngitis, typically administered for 10 days 6, 8, 9.
- However, alternatives to penicillin V are available, including other penicillins, macrolides, and cephalosporins, which may offer advantages such as simpler and shorter dosing regimens or improved palatability 6, 10, 9.
- Azithromycin has been shown to be effective in treating GABHS pharyngitis, with a total dose of 60 mg/kg given over 3 or 5 days constituting an alternative treatment to standard penicillin therapy 6.
- Clarithromycin has also been compared to penicillin in the treatment of streptococcal pharyngitis, with results suggesting that clarithromycin is as effective and well-tolerated as penicillin 10.
- Cephalosporins, such as cefdinir and cefpodoxime proxetil, may provide higher bacteriologic eradication rates than penicillin V and offer more convenient dosing schedules, potentially improving adherence to treatment 9.
Non-Antibiotic Treatment
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective than acetaminophen and placebo for treating fever and pain associated with GABHS pharyngitis 8.
- Medicated throat lozenges used every two hours are also effective in relieving symptoms 8.
- Corticosteroids may provide a small reduction in the duration of symptoms but are not recommended for routine use 8.