From the Guidelines
Penicillin V potassium (Pen VK) is the first-line antibiotic treatment for strep throat in pregnant patients, typically prescribed as 500 mg orally twice daily for 10 days, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- This medication is considered pregnancy category B and has a long history of safe use during pregnancy.
- For patients with penicillin allergy, alternative treatments such as cephalexin or clindamycin can be used, though they may have slightly lower efficacy or different dosing regimens 1.
- Complete adherence to the full 10-day course is essential even if symptoms improve earlier, as this helps prevent complications like rheumatic fever and ensures bacterial eradication.
Treatment Options
- Penicillin V: 500 mg orally twice daily for 10 days
- Amoxicillin: 50 mg/kg once daily (max = 1000 mg) for 10 days, as an alternative to penicillin V 1
- Cephalexin: 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days, for patients with non-anaphylactic penicillin allergies 1
Symptomatic Relief
- Acetaminophen for pain and fever
- Warm salt water gargles
- Adequate hydration
- Avoiding NSAIDs during pregnancy, especially in the third trimester
Importance of Treatment
- Treating strep throat during pregnancy is important not only for maternal comfort but also to prevent potential complications such as peritonsillar abscess or transmission to the newborn during delivery.
- Prevention of rheumatic fever and other nonsuppurative postinfectious disorders is a key consideration in the treatment of strep throat in pregnant patients 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 antibiotic for streptococcal pharyngitis (strep throat) in a pregnant patient is penicillin, as it is the usual drug of choice. However, if the patient is unable to use penicillin, azithromycin may be considered as an alternative therapy 2.
From the Research
Antibiotic Recommendations for Streptococcal Pharyngitis in Pregnant Patients
- The recommended antibiotic for streptococcal pharyngitis (strep throat) in pregnant patients is penicillin, as it is the most effective treatment and has a narrow spectrum of activity 3, 4.
- For patients allergic to penicillin, alternatives such as erythromycin, first-generation cephalosporins, or newer macrolides like clarithromycin and azithromycin may be used 3, 4.
- Amoxicillin is also an effective option and is more palatable than penicillin 4.
- Skin testing and oral amoxicillin challenge can be safely performed in pregnant women to assess penicillin allergy, and this evaluation can lead to the safe removal of the penicillin allergy label and increased use of first-line beta-lactam antibiotics 5, 6.
Considerations for Penicillin Allergy Evaluation in Pregnancy
- Penicillin allergy evaluation is important in pregnant patients, as it can impact antibiotic use and outcomes 5, 6.
- Studies have shown that penicillin allergy testing is safe in pregnant women and can lead to reduced use of broad-spectrum antibiotics and increased use of first-line beta-lactam antibiotics 5, 6.
- The use of penicillin and other beta-lactam antibiotics is recommended for group B Streptococcus and cesarean section prophylaxis, making accurate penicillin allergy evaluation crucial in pregnant patients 6.