From the Guidelines
Penicillin V is the recommended first-line antibiotic treatment for streptococcal pharyngitis, with a dosage of 250 mg twice daily or 500 mg twice daily for 10 days, as it has a strong, high-quality recommendation 1.
Recommended Antibiotics for Strep Pharyngitis
The following antibiotics are recommended for the treatment of streptococcal pharyngitis:
- For individuals without penicillin allergy:
- For individuals with penicillin allergy:
- Cephalexin, oral: 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days 1
- Cefadroxil, oral: 30 mg/kg once daily (max = 1 g) for 10 days 1
- Clindamycin, oral: 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days 1
- Azithromycin, oral: 12 mg/kg once daily (max = 500 mg) for 5 days 1
- Clarithromycin, oral: 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days 1
Importance of Accurate Diagnosis and Treatment
Accurate diagnosis of streptococcal pharyngitis is crucial to prevent unnecessary antibiotic use and reduce the risk of complications such as acute rheumatic fever and poststreptococcal glomerulonephritis 1. Antibiotic treatment should be initiated promptly after diagnosis, and patients should complete the full course of treatment even if symptoms improve before finishing 1.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx
The recommended antibiotics for streptococcal (strep) pharyngitis are:
- Penicillin (by the intramuscular route) as the first-line therapy
- Azithromycin as an alternative to first-line therapy in individuals who cannot use first-line therapy 2, 2, 2
From the Research
Recommended Antibiotics for Streptococcal Pharyngitis
The following antibiotics are recommended for the treatment of streptococcal pharyngitis:
- Penicillin V, given for 10 days, 2 or 3 times per day 3
- Cephalosporins, which may provide higher bacteriologic eradication rates than penicillin V, and can be administered for 10 days or, in some cases, for a shorter duration of 5 days 3, 4
- Macrolides, such as azithromycin, which can be given for 5 days, but may have a higher rate of recurrence of infection than penicillin V 5, 6
- Clarithromycin, which can be given for 10 days, and is a rational alternative to erythromycin for streptococcal pharyngitis/tonsillitis in penicillin-allergic patients 6
Alternative Treatment Options
Alternative treatment options for streptococcal pharyngitis include:
- Amoxicillin, which can be given for 10 days 7
- Cefdinir, which can be given for 5 or 10 days, and may offer an alternative to penicillin V for children with streptococcal pharyngitis, particularly when compliance is a clinical concern 3
- Cefpodoxime proxetil, which can be given for 5 days, and is a third-generation cephalosporin that may provide higher bacteriologic eradication rates than penicillin V 3
Considerations for Treatment
When selecting a treatment option for streptococcal pharyngitis, considerations should include:
- The patient's allergy status, particularly to penicillin 6, 3
- The potential for treatment failure, which may be caused by lack of compliance, reexposure to Streptococcus-infected family members or peers, copathogenicity, antibiotic-associated eradication of normal protective pharyngeal flora, or penicillin tolerance 4
- The palatability of the antibiotic, particularly for children 3