From the Guidelines
Strep pharyngitis is best treated with a 10-day course of oral penicillin or amoxicillin, as recommended by the Infectious Diseases Society of America in 2012 1. The symptoms of Streptococcal pharyngitis include severe sore throat, fever, and swollen lymph nodes, and are caused by group A Streptococcus bacteria. Treatment options for Strep pharyngitis are as follows:
- For non-allergic patients, penicillin or amoxicillin is the recommended drug of choice, due to their narrow spectrum of activity, infrequency of adverse reactions, and modest cost 1.
- For penicillin-allergic individuals, alternative treatments include a first-generation cephalosporin, clindamycin, or clarithromycin for 10 days, or azithromycin for 5 days 1. Supportive care for Strep pharyngitis includes:
- Adequate hydration
- Rest
- Pain management with acetaminophen or ibuprofen Patients are generally considered non-contagious after 24 hours of antibiotic therapy and can return to normal activities. It is essential to complete the full course of antibiotics to prevent complications like rheumatic fever. Symptoms usually improve within 24-48 hours of starting antibiotics. The diagnosis of Strep pharyngitis is typically made using rapid antigen detection tests or throat cultures. Prompt treatment helps prevent the spread of the infection and serious complications.
From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.
The symptoms of Streptococcal (Strep) pharyngitis are not directly mentioned in the provided drug labels. Treatment options for Streptococcal (Strep) pharyngitis include:
- Penicillin (first-line therapy) 2
- Azithromycin (as an alternative to first-line therapy in individuals who cannot use first-line therapy) 3 A minimum of ten-day therapy is required to eliminate the organism and prevent sequelae of streptococcal disease 2.
From the Research
Symptoms of Streptococcal Pharyngitis
- Sore throat
- Temperature greater than 100.4 degrees F (38 degrees C)
- Tonsillar exudates
- Cervical adenopathy
- Cough, coryza, and diarrhea are more common with viral pharyngitis 4
Treatment Options
- Penicillin is the drug of choice for acute streptococcal pharyngitis, with a treatment duration of 10 days 5, 6, 4
- Alternatives for patients allergic to penicillin include:
- Amoxicillin is equally effective as penicillin and more palatable 4
- Newer macrolides such as clarithromycin and azithromycin offer lower rates of gastrointestinal complaints and more convenient dosing 5
Diagnostic Tests
- Throat culture is considered the diagnostic standard 4
- Rapid antigen detection testing has improved sensitivity and specificity, and can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 4, 8
- The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 4
Prevention of Complications
- Antibiotic therapy may help prevent acute rheumatic fever, reduce the risk of locoregional suppuration, and relieve symptoms 5, 6, 8
- However, there is no convincing evidence that antibiotics relieve symptoms in children, and the risk of acute glomerulonephritis is not significantly reduced by antibiotic therapy 8