What is the treatment for throat bleeding with streptococcal infection?

Treatment for Throat Bleeding with Streptococcal Infection

Throat bleeding with streptococcal pharyngitis should be treated with a full 10-day course of penicillin as first-line therapy, along with appropriate supportive care to manage bleeding and pain. 1, 2

Antibiotic Therapy

First-line Treatment:

• Penicillin V:
  • Children: 250 mg 2-3 times daily for 10 days
  • Adolescents/Adults: 500 mg 2-3 times daily for 10 days 2
• Amoxicillin (alternative, especially for young children):
  • 50 mg/kg once daily (maximum 1000 mg) or
  • 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 2
• Intramuscular benzathine penicillin G is preferred for patients unlikely to complete the full oral course 1

For Penicillin-Allergic Patients:

• Non-anaphylactic allergy:
  • First-generation cephalosporins (e.g., cephalexin) 2
• Immediate/anaphylactic hypersensitivity:
  • Clindamycin: 300-450 mg orally three times daily for 10 days (adults) 2, 3
  • Azithromycin: 12 mg/kg once daily (max 500 mg) for 5 days 2

Management of Throat Bleeding

1. Assess severity of bleeding:

   • Minor bleeding may be managed conservatively
   • Severe bleeding requires immediate medical attention

2. Supportive measures:

   • Cold liquids or ice chips to constrict blood vessels
   • Gargling with cold water or ice water
   • Avoid hot liquids, spicy foods, and hard foods that may irritate the throat

3. Pain management:

   • NSAIDs (ibuprofen) or acetaminophen for pain and inflammation
   • Throat lozenges and warm salt water gargles for symptomatic relief 2

Important Considerations

• Complete the full antibiotic course: Failure to complete the full 10-day course (except for azithromycin which is 5 days) increases risk of treatment failure and complications like acute rheumatic fever 2, 4

• Monitor for complications: Watch for signs of worsening infection, increased bleeding, difficulty breathing, or dehydration

• Follow-up: Patients with persistent bleeding or worsening symptoms after 48-72 hours of antibiotic therapy should be reevaluated 5

• Avoid treatment pitfalls:

  • Do not rely on oral antibiotics in patients with severe illness, nausea, vomiting, or intestinal hypermotility as absorption may be compromised 4
  • Penicillin treatment failures occur in 5-35% of cases, particularly in patients recently treated with penicillin 6
  • Consider alternative antibiotics if patient has history of penicillin treatment failures 6

Special Situations

• Recurrent streptococcal infections: Consider evaluation for carrier state or alternative antibiotic regimens 1

• Severe cases with significant bleeding: May require otolaryngology consultation for potential cauterization or other interventions

• Tonsillectomy consideration: May be appropriate for patients with recurrent streptococcal pharyngitis (7+ episodes in one year, 5+ episodes per year for 2 years, or 3+ episodes per year for 3 years) 2, 5

The primary goals of treatment are to eradicate the infection, prevent complications (including acute rheumatic fever and suppurative complications), reduce symptoms, and prevent transmission to others 1. While shorter antibiotic courses (5-7 days) have shown similar effectiveness in some studies 7, the standard 10-day course remains recommended by major guidelines to ensure complete eradication of group A streptococci 1, 2.