What medication should I take for strep throat?

Treatment for Strep Throat

Penicillin or amoxicillin is the first-line treatment for strep throat, with a standard 10-day course recommended for complete eradication of Group A Streptococcal (GAS) pharyngitis. 1

First-Line Treatment Options

For Non-Allergic Patients:

• Penicillin V:

  • Children: 250 mg 2-3 times daily for 10 days
  • Adolescents/Adults: 500 mg 2-3 times daily for 10 days 1

• Amoxicillin:

  • 50 mg/kg once daily (maximum 1000 mg) OR
  • 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1
  • Note: Amoxicillin is equally effective as penicillin and more palatable, especially for children 2

Alternative Options for Penicillin-Allergic Patients

For Mild Penicillin Allergy (non-anaphylactic):

• First-generation cephalosporins:
  • Cephalexin: 20 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1

For Severe Penicillin Allergy (anaphylactic):

• Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1

  • Preferred for patients allergic to both penicillin and cephalosporins 1

• Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days 1, 3

  • Note: Increasing resistance rates may limit effectiveness 1

Symptomatic Treatment

In addition to antibiotics, the following can help manage symptoms:

• NSAIDs: Ibuprofen 400 mg every 6-8 hours as needed (adults) for pain and fever reduction 1
• Acetaminophen: 500-1000 mg every 4-6 hours as needed (adults) as an alternative 1
• Warm salt water gargles: For temporary symptomatic relief 1
• Topical anesthetics: Lozenges or sprays containing benzocaine or lidocaine for temporary relief 1

Important Considerations

Diagnostic Confirmation

• Diagnosis should be confirmed with throat culture or rapid antigen detection test (RADT) before starting antibiotics 1, 2
• Clinical features supporting GAS diagnosis include fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough 1

Treatment Pitfalls to Avoid

1. Avoid corticosteroids: The Infectious Diseases Society of America explicitly recommends against corticosteroid use for pharyngitis 1
2. Avoid aspirin in children: Due to risk of Reye syndrome 1
3. Complete the full course: Failure to complete the full 10-day course of antibiotics (5 days for azithromycin) can lead to treatment failure and complications 1
4. Be aware of increasing penicillin failure rates: Bacteriologic failure rates with penicillin have increased over time, potentially due to poor compliance with the 10-day regimen 4

Return to Normal Activities

• Patients are generally no longer contagious after 24 hours of appropriate antibiotic therapy 1
• Should complete the full course of antibiotics despite symptom improvement 1

Special Considerations

• Routine post-treatment throat cultures are not recommended for asymptomatic individuals who have completed appropriate antibiotic therapy 1
• Chronic carriers generally do not require treatment as they are unlikely to spread GAS to contacts and are at minimal risk for developing complications 1

While some studies suggest cephalosporins may have better eradication rates than penicillin 4, 5, 6, current guidelines still recommend penicillin or amoxicillin as first-line therapy due to their proven efficacy, narrow spectrum of activity, and low cost 1, 2.