What is the treatment for strep throat symptoms?

Treatment for Strep Throat Symptoms

Penicillin V or amoxicillin for 10 days is the first-line treatment for streptococcal pharyngitis, with alternatives available for penicillin-allergic patients. 1

Diagnosis of Streptococcal Pharyngitis

Before initiating treatment, proper diagnosis is essential:

1. Clinical Assessment using Centor Criteria:

   • Fever >100.4°F (38°C)
   • Tonsillar exudates
   • Tender anterior cervical lymphadenopathy
   • Absence of cough 1

2. Testing Recommendations:

   • 0-2 Centor criteria: No testing or antibiotics needed
   • 3-4 Centor criteria: Perform rapid antigen detection test (RADT) and/or throat culture 2, 1
   • Avoid testing when viral symptoms predominate (cough, rhinorrhea, hoarseness, oral ulcers) 2

3. Laboratory Confirmation:

   • RADT has high specificity (96-98%) but variable sensitivity (65-75%) 3
   • Negative RADT results should be confirmed with throat culture in children 2
   • In adults, negative RADT without culture confirmation is acceptable due to lower prevalence of GAS and minimal risk of rheumatic fever 2

Antibiotic Treatment

First-line Treatment:

• Penicillin V:

  • Children: 250 mg 2-3 times daily for 10 days
  • Adults: 500 mg 2-3 times daily for 10 days 1, 4

• Amoxicillin (alternative, especially for children due to better taste):

  • 50 mg/kg once daily (max 1000 mg) or 25 mg/kg twice daily (max 500 mg per dose) for 10 days 1

For Penicillin-Allergic Patients:

• Non-anaphylactic allergy: Cephalexin or cefadroxil for 10 days 1
• Anaphylactic allergy:
  • Clindamycin: 7 mg/kg three times daily (max 300 mg per dose) for 10 days
  • Azithromycin: 12 mg/kg once daily (max 500 mg) for 5 days 1, 5

Important: Macrolides (azithromycin, erythromycin) should be reserved for penicillin-allergic patients due to increasing resistance patterns 1, 5

Treatment Duration and Adherence

• Complete the full 10-day course of antibiotics (except azithromycin, which is 5 days) 2, 1
• Failure to complete the full course may lead to:
  • Treatment failure
  • Risk of rheumatic fever
  • Increased bacterial resistance 1, 4
• Patients are considered non-contagious after 24 hours of appropriate antibiotic therapy 1

Symptom Management

For relief of symptoms while antibiotics take effect:

• NSAIDs (ibuprofen): First-line for pain and fever management 2, 1
• Acetaminophen: Alternative for pain and fever relief 1
• Supportive measures: Warm salt water gargles and throat lozenges 1

Special Considerations

Recurrent Infections

• Consider alternative regimens including clindamycin or combination therapy with rifampin 1
• For chronic carriers, decolonization strategies may be needed 1

Complications and Follow-up

• Routine follow-up is not necessary for uncomplicated cases 1
• Patients should seek medical attention if symptoms persist or worsen after 48-72 hours of antibiotic therapy 1

Common Pitfalls to Avoid

1. Treating viral pharyngitis with antibiotics: Most sore throats are viral and do not require antibiotics 2
2. Incomplete antibiotic courses: The full 10-day course is essential to prevent complications 2, 1
3. Relying solely on clinical features: Laboratory confirmation is important, especially in high-risk patients 2
4. Overlooking non-Group A streptococcal causes: Group C and G streptococci can also cause severe pharyngitis 6
5. Ignoring local resistance patterns: These should inform antibiotic selection 1

By following this evidence-based approach to diagnosing and treating streptococcal pharyngitis, clinicians can ensure appropriate antibiotic use while effectively managing symptoms and preventing complications.