Treatment for Streptococcal (Strep) Throat
Oral penicillin V (500 mg 2-3 times daily for adults/adolescents or 250 mg 2-3 times daily for children) or amoxicillin (50 mg/kg once daily, maximum 1000 mg) for 10 days is the first-line treatment for strep throat. 1
First-Line Treatment Options
Penicillin-Based Therapy
- Penicillin V:
- Children: 250 mg 2-3 times daily for 10 days
- Adults/Adolescents: 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
Important: Complete the full 10-day course of antibiotics even if symptoms improve quickly to prevent sequelae of streptococcal disease 1, 2
Alternative Options for Penicillin-Allergic Patients
For patients with penicillin allergy:
- Narrow-spectrum oral cephalosporins (e.g., cephalexin): 20 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1
- Note: Cephalosporin cross-reactivity occurs in about 10% of penicillin-allergic patients 1
- Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1
- Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days 1, 3
- Caution: Some strains of Streptococcus pyogenes are resistant to azithromycin, so susceptibility testing should be performed when using this alternative 3
Symptomatic Treatment
In addition to antibiotics, symptomatic relief can be provided with:
- NSAIDs (first-line for pain management) 1
- Acetaminophen for pain and fever 1
- Warm salt water gargles 1
- Throat lozenges 1
Important Clinical Considerations
Contagiousness
- Patients are considered non-contagious after 24 hours of appropriate antibiotic therapy 1
- Healthcare workers with strep throat should remain isolated from patient care until they have completed at least 24 hours of appropriate antibiotic therapy 1
Medication Administration Cautions
- The oral route should not be relied upon in patients with severe illness, nausea, vomiting, gastric dilatation, cardiospasm, or intestinal hypermotility 2
- Some patients may not absorb therapeutic amounts of orally administered penicillin 2
Follow-up
- Patients should be advised to return if symptoms persist beyond 7 days, difficulty swallowing or breathing develops, high fever persists despite antipyretics, or if purulent tonsillar exudates or tender cervical lymphadenopathy develops 1
- Routine post-treatment throat cultures are not recommended for asymptomatic individuals who have completed appropriate antibiotic therapy 1
Potential Pitfalls
Inadequate treatment duration: Failing to complete the full 10-day course of antibiotics may lead to treatment failure and risk of rheumatic fever 1, 2
Inappropriate antibiotic selection: Using antibiotics without confirming strep infection increases the risk of developing drug-resistant bacteria 2, 3
Overlooking penicillin allergy: Always verify allergy status before prescribing penicillin-based treatments 1
Ignoring treatment failure: If symptoms persist after treatment, consider resistant organisms or alternative diagnoses 1
Superinfection risk: Prolonged antibiotic use may promote overgrowth of nonsusceptible organisms, including fungi 2