What is the treatment for Streptococcal (Strepto) infection?

From the Guidelines

Strep throat is typically treated with antibiotics, specifically penicillin or amoxicillin, which are the first-line treatments. For adults, the recommended dosage is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days, as supported by the Infectious Diseases Society of America guidelines 1. For children, the dosage is weight-based, usually 250-500 mg of amoxicillin twice daily for 10 days. For those allergic to penicillin, alternatives include azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) or clindamycin (300 mg three times daily for 10 days) 1.

Key Considerations

• It's essential to complete the full course of antibiotics even if symptoms improve before finishing the medication.
• While waiting for antibiotics to work, over-the-counter pain relievers like acetaminophen or ibuprofen can help manage throat pain and fever.
• Gargling with warm salt water and staying hydrated also provide relief.
• Antibiotics are crucial for treating strep throat because they prevent serious complications like rheumatic fever and kidney inflammation, and they reduce the contagious period, typically making patients non-contagious after 24 hours of antibiotic treatment.

Treatment Options

• Penicillin and its congeners (such as ampicillin and amoxicillin) are effective in treating group A streptococcal pharyngitis.
• Numerous cephalosporins and macrolides, and clindamycin, are also effective alternatives.
• Erythromycin is a suitable alternative for patients allergic to penicillin.
• First-generation cephalosporins are also acceptable for patients allergic to penicillin who do not manifest immediate-type hypersensitivity to β-lactam antibiotics.

Duration of Treatment

• Most oral antibiotics must be administered for the conventional 10 days to achieve maximal rates of pharyngeal eradication of group A streptococci.
• Some antibiotics, such as clarithromycin, cefuroxime, cefixime, ceftibuten, cefdinir, cefpodoxime, and azithromycin, may be effective in eradicating group A streptococci from the pharynx when administered for 5 days, although only the latter 3 are approved for a 5-day course of therapy by the US Food and Drug Administration (FDA) 1.

From the FDA Drug Label

In streptococcal infections, therapy must be sufficient to eliminate the organism (10-day minimum); otherwise the sequelae of streptococcal disease may occur. 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.

The treatment for Streptococcal (Strepto) infection is:

• Penicillin (by the intramuscular route) for a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease 2
• Azithromycin may be used as an alternative to first-line therapy in individuals who cannot use first-line therapy, but susceptibility tests should be performed to ensure the causative organism is susceptible to azithromycin 3

From the Research

Treatment Options for Streptococcal Infection

The treatment for Streptococcal (Strepto) infection typically involves antibiotics. The following are some of the treatment options:

• Penicillin is the most commonly recommended treatment for group A streptococcal pharyngitis, with a usual dose of 250 mg (400,000 IU) three times daily for 10 days 4, 5.
• Oral cephalosporins, such as cefpodoxime proxetil, have been shown to be significantly superior to penicillin V in eradicating group A streptococci from the pharynx 4.
• Azithromycin is also an effective alternative treatment for streptococcal pharyngitis, with a dosage of 500 mg once on day 1 followed by 250 mg once daily for 4 days 6.
• Other alternatives to penicillin V include other penicillins, macrolides, and cephalosporins, such as cefdinir and cefpodoxime proxetil, which can be administered twice daily for 10 days or in a 5-day dosing schedule 7.
• Azithromycin has also been shown to be effective in pediatric patients with acute streptococcal pharyngitis/tonsillitis, with a dosage of 10 or 20 mg/kg/day once daily for 3 days 8.

Dosage and Administration

The dosage and administration of antibiotics for streptococcal infection vary depending on the specific medication and patient population. Some key points to note:

• Penicillin V is typically administered 2 or 3 times per day for 10 days 4, 5.
• Cefpodoxime proxetil can be administered twice daily for 10 days or in a 5-day dosing schedule 4, 7.
• Azithromycin can be administered once daily for 3-5 days 6, 8.
• The dosage of azithromycin for pediatric patients is 10 or 20 mg/kg/day once daily for 3 days 8.

Efficacy and Safety

The efficacy and safety of antibiotics for streptococcal infection have been evaluated in several studies. Some key findings:

• Penicillin V has been shown to be effective in eradicating group A streptococci from the pharynx, but may have a higher failure rate compared to oral cephalosporins 4.
• Azithromycin has been shown to be effective in treating streptococcal pharyngitis, with a satisfactory clinical response rate of 99% 6.
• Cefpodoxime proxetil has been shown to be significantly superior to penicillin V in eradicating group A streptococci from the pharynx 4.
• Azithromycin has been shown to be safe and effective in pediatric patients with acute streptococcal pharyngitis/tonsillitis, with a low rate of treatment-related adverse events 8.