How to stop strep throat

How to Treat and Stop Strep Throat

The most effective way to stop strep throat is to complete a full 10-day course of penicillin or amoxicillin, which remains the first-line treatment due to proven efficacy, safety, narrow spectrum, and low cost. 1

First-Line Treatment Options

For Patients Without Penicillin Allergy:

• Oral Options:

  • Penicillin V:
    • Children: 250 mg 2-3 times daily for 10 days
    • Adults: 250 mg 4 times daily or 500 mg twice daily for 10 days 1
  • Amoxicillin:
    • 50 mg/kg once daily (maximum 1,000 mg) for 10 days, or
    • 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1

• Parenteral Option:

  • Benzathine Penicillin G (intramuscular): For patients unlikely to complete the full oral course
    • Patients <27 kg: 600,000 units
    • Patients ≥27 kg: 1,200,000 units 1, 2

For Patients With Penicillin Allergy:

• Non-anaphylactic allergy:

  • First-generation cephalosporins: (e.g., cephalexin, cefadroxil) for 10 days 1, 2
    • Cephalexin: 20 mg/kg twice daily (maximum 500 mg per dose)
    • Cefadroxil: 30 mg/kg once daily (maximum 1 g)

• Anaphylactic allergy:

  • Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1, 2
  • Clarithromycin: 7.5 mg/kg twice daily (maximum 250 mg per dose) for 10 days 1, 2
  • Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days 1, 2

Importance of Completing the Full Course

It is crucial to complete the full 10-day course of antibiotics, even if symptoms resolve earlier. The FDA label for penicillin specifically warns:

"In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum); otherwise the sequelae of streptococcal disease may occur." 3

Skipping doses or not completing the full course may:

• Decrease the effectiveness of immediate treatment
• Increase the likelihood of bacteria developing resistance
• Fail to prevent complications like acute rheumatic fever 1, 3

Symptomatic Relief

While waiting for antibiotics to work:

• Pain and fever management: Acetaminophen or NSAIDs (avoid aspirin in children due to risk of Reye syndrome) 2, 1
• Topical remedies: Lozenges and warm salt water gargles for patients old enough to gargle 1

Special Considerations

For Recurrent Strep Throat:

If a patient experiences multiple recurrent episodes, consider:

• Alternative antibiotics like clindamycin (20-30 mg/kg/day in three doses, maximum 300 mg per dose) for 10 days 2
• Amoxicillin/clavulanate (40 mg amoxicillin/kg/day in three doses, maximum 2,000 mg amoxicillin/day) for 10 days 2
• Tonsillectomy for patients with ≥7 episodes in the past year, ≥5 episodes per year for 2 consecutive years, or ≥3 episodes per year for 3 consecutive years 1

Follow-up:

• Routine follow-up throat cultures or rapid antigen detection tests are not recommended after treatment 1
• If symptoms worsen after starting antibiotics or persist for 5 days after treatment initiation, the patient should be reevaluated 4

Common Pitfalls to Avoid

1. Insufficient treatment duration: Despite some research suggesting shorter courses might be effective 5, current guidelines still strongly recommend completing the full 10-day course to prevent complications 1, 3

2. Using inappropriate antibiotics: Avoid tetracyclines, sulfonamides, trimethoprim-sulfamethoxazole, and older fluoroquinolones as they are ineffective against Group A Streptococcus 2

3. Ignoring macrolide resistance: In some areas of the US, resistance rates to azithromycin and clarithromycin are around 5-8%, which could lead to treatment failures 2

4. Stopping antibiotics when symptoms improve: This is a common cause of treatment failure and can lead to complications 6

5. Corticosteroids: These are not routinely recommended for symptomatic treatment 2, 1

By following these evidence-based guidelines, strep throat can be effectively treated while minimizing complications and antibiotic resistance.