What is the recommended management for strep throat?

From the Guidelines

The recommended management for strep throat is a 10-day course of oral antibiotics, with penicillin V (250-500 mg twice daily for adults) or amoxicillin (50 mg/kg once daily for children, max = 1000 mg) as first-line treatments, as stated in the 2012 update by the Infectious Diseases Society of America 1.

Key Considerations

• For individuals without penicillin allergy, penicillin V or amoxicillin are the preferred treatments due to their strong, high-quality evidence supporting their use 1.
• For individuals with penicillin allergy, alternatives such as cephalexin, cefadroxil, clindamycin, azithromycin, or clarithromycin can be used, with consideration of the patient's specific allergy and the potential for resistance to these agents 1.

Symptomatic Relief and Prevention of Complications

• Symptomatic relief can be achieved with acetaminophen or ibuprofen for pain and fever, warm salt water gargles, and adequate hydration.
• Patients should rest and stay home from work or school for at least 24 hours after starting antibiotics to prevent transmission.
• Completing the full antibiotic course is crucial to prevent complications like rheumatic fever or kidney inflammation, even if symptoms improve quickly.

Rationale for Antibiotic Use

• Antibiotics are effective because they eliminate the causative bacteria (Group A Streptococcus), reduce symptom duration, prevent complications, and decrease contagiousness 1.

Expected Outcome

• Most patients will feel better within 2-3 days of starting treatment, but should contact their healthcare provider if symptoms worsen or don't improve after 48 hours of antibiotic therapy.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and other antibacterial drugs, amoxicillin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria 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. Cefuroxime axetil tablets are indicated for the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms in the conditions listed below: Pharyngitis/Tonsillitis caused by Streptococcus pyogenes

The recommended management for strep throat is:

• Antibiotic treatment: with a duration of at least 10 days to prevent the occurrence of acute rheumatic fever
• Amoxicillin or cefuroxime axetil can be used to treat strep throat, but the choice of antibiotic should be based on the susceptibility of the bacteria and the patient's medical history 2 3
• Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained Key points:
• The treatment of strep throat should be guided by culture and susceptibility information
• Penicillin is the usual drug of choice in the treatment and prevention of streptococcal infections, including the prophylaxis of rheumatic fever
• Local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy in the absence of culture and susceptibility information

From the Research

Strep Throat Management

The management of strep throat involves the use of antibiotics to prevent acute rheumatic fever and suppurative complications, hasten resolution of clinical signs and symptoms, and prevent transmission to close contacts 4.

Diagnosis

Streptococcal pharyngitis usually cannot be reliably distinguished from other etiologies on the basis of epidemiologic or physical findings, and therefore a throat culture or a rapid antigen detection test is generally necessary to confirm the diagnosis 4.

Treatment Options

The recommended first-line therapy for streptococcal pharyngitis is a 10-day course of penicillin V, usually given 2 or 3 times per day 4. Some key points about treatment options include:

• Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days 5.
• First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 5.
• Azithromycin and clarithromycin are not recommended in areas with high resistance rates 6, 7, 5.
• A 5-day course of amoxicillin/clavulanate may be as effective as a 10-day course of penicillin V 7.
• Cephalosporins may provide higher bacteriologic eradication rates than penicillin V 4.

Dosing Frequency

The dosing frequency of antibiotics can impact efficacy, with twice-daily dosing of penicillin being as effective as more frequent dosing regimens 8. Some key points about dosing frequency include:

• Twice-daily dosing of penicillin is as efficacious as more frequent dosing regimens 8.
• Once-daily dosing of penicillin is associated with decreased efficacy and should not be used 8.
• Amoxicillin may be effective when given once daily, but this should be further investigated 8.

Symptomatic Treatment

Steroids are not recommended for symptomatic treatment of strep throat 5. Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 5.