From the Guidelines
For patients with strep throat who are allergic to penicillin (PCN), the recommended treatment is cephalexin, cefadroxil, clindamycin, azithromycin, or clarithromycin, with cephalexin being a preferred option for those with non-severe penicillin allergy due to its low cross-reactivity rate of around 5-10% 1.
Treatment Options
- Cephalexin: 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days, as it is a narrow-spectrum cephalosporin with a low cross-reactivity rate with penicillin 1.
- Cefadroxil: 30 mg/kg once daily (max = 1 g) for 10 days, as it is another narrow-spectrum cephalosporin option for penicillin-allergic patients 1.
- Clindamycin: 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days, as it is an effective alternative for those with severe penicillin allergy, with a resistance rate of approximately 1% among GAS isolates in the United States 1.
- Azithromycin: 12 mg/kg once daily (max = 500 mg) for 5 days, as it is a macrolide option for penicillin-allergic patients, although resistance rates may vary geographically and temporally 1.
- Clarithromycin: 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days, as it is another macrolide option, with a resistance rate of around 5-8% in some areas of the United States 1.
Importance of Completing the Full Course
It is crucial to complete the full course of antibiotics, even if symptoms improve quickly, to prevent complications like rheumatic fever and to ensure the eradication of the organism from the pharynx 1.
Symptomatic Treatments
Patients should also use symptomatic treatments such as acetaminophen or ibuprofen for pain and fever, and warm salt water gargles for throat discomfort to manage their symptoms effectively 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 treatment for penicillin (PCN) allergic patients with streptococcal pharyngitis is azithromycin as an alternative to first-line therapy.
- Key points:
- Azithromycin is effective in eradicating susceptible strains of Streptococcus pyogenes from the nasopharynx.
- Susceptibility tests should be performed when patients are treated with azithromycin due to potential resistance.
- Data establishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available 2
From the Research
Treatment for Penicillin (PCN) Allergic Patients with Streptococcal Pharyngitis
- For patients allergic to penicillin, alternative treatments are available, including:
- The choice of alternative treatment depends on the severity of the allergy and the patient's medical history
- It is essential to note that cephalosporins may provide higher bacteriologic eradication rates than penicillin V 5, 6
Dosage and Duration of Treatment
- The recommended duration of treatment for streptococcal pharyngitis is 10 days 5, 3, 6, 7, 4
- Some cephalosporins, such as cefdinir and cefpodoxime proxetil, can be administered in a 5-day dosing schedule 5, 6
- The dosage and frequency of administration vary depending on the chosen antibiotic and the patient's age and weight
Importance of Treatment
- Treatment of streptococcal pharyngitis is crucial to prevent acute rheumatic fever and suppurative complications, hasten resolution of clinical signs and symptoms, and prevent transmission to close contacts 3, 6, 7
- Early treatment can reduce the duration of symptoms, decrease the incidence of suppurative complications, and limit the spread of the disease 7