Amoxicillin 875mg Twice Daily for Strep Throat
Yes, 875mg of amoxicillin twice daily is an appropriate dose for an adult with confirmed strep throat. 1 This dosing regimen is FDA-approved and recommended in clinical practice guidelines for the treatment of Group A Streptococcal (GAS) pharyngitis.
Recommended Dosing for Strep Throat
According to the 2012 Infectious Diseases Society of America (IDSA) guidelines for the management of Group A Streptococcal pharyngitis, the following options are recommended for adults:
- Penicillin V: 250mg four times daily or 500mg twice daily for 10 days (strong recommendation, high-quality evidence) 2
- Amoxicillin: 50mg/kg once daily (maximum 1,000mg) or 25mg/kg twice daily (maximum 500mg per dose) for 10 days (strong recommendation, high-quality evidence) 2
For adults, the FDA-approved amoxicillin dosing for upper respiratory tract infections includes 875mg twice daily, which is appropriate for strep throat 1.
Duration of Treatment
- Treatment should continue for a full 10 days to ensure complete eradication of the organism and prevent complications such as acute rheumatic fever 2, 1
- It is specifically recommended that there be at least 10 days' treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever 1
Alternative Options for Penicillin-Allergic Patients
If the patient has a penicillin allergy, alternative options include:
- Cephalexin: 500mg four times daily for 10 days (if no immediate hypersensitivity to penicillin)
- Clindamycin: 300mg three times daily for 10 days
- Azithromycin: 500mg once daily for 5 days
- Clarithromycin: 250mg twice daily for 10 days 2
Important Clinical Considerations
- Amoxicillin should be taken at the start of a meal to minimize gastrointestinal intolerance 1
- Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic 1
- Patients with severe renal impairment (GFR <30 mL/min) should NOT receive the 875mg dose 1
Compliance Considerations
The twice-daily dosing of amoxicillin 875mg may improve patient compliance compared to more frequent dosing regimens like penicillin V four times daily 3. Some studies have even explored once-daily dosing of amoxicillin for strep throat with comparable efficacy to twice-daily dosing 4, 5.
Monitoring and Follow-up
- Routine post-treatment testing is not recommended for asymptomatic patients 2
- Clinical improvement should be seen within 24-48 hours of starting antibiotics
- If symptoms persist beyond 72 hours, reevaluation should be considered
By following these evidence-based recommendations, you can effectively treat adult patients with confirmed strep throat using amoxicillin 875mg twice daily for 10 days.