Treatment of Strep Throat
Penicillin V is the first-line treatment for strep throat (Group A Streptococcal pharyngitis), with a recommended dose of 250 mg three times daily for 10 days for adults. 1
First-Line Treatment Options
For Adults:
- Penicillin V: 250 mg orally three times daily for 10 days 1
For Children:
- Penicillin V:
- For children <27 kg: 600,000 U orally divided doses for 10 days
- For children ≥27 kg: 1,200,000 U orally divided doses for 10 days 1
- Amoxicillin: 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1
- Amoxicillin is often preferred for children due to better taste and twice-daily dosing option
Alternative Treatment Options (for Penicillin-Allergic Patients)
- Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days 1, 2
- Clindamycin: 300-450 mg orally three times daily for 10 days 1
Important Clinical Considerations
Duration of Therapy
- 10-day treatment is essential for all beta-lactam antibiotics (penicillin, amoxicillin) to prevent acute rheumatic fever 1, 3
- Shorter courses (5-7 days) may be considered for azithromycin only 1, 2
Return to School/Work
- Patients are considered non-contagious after 24 hours of effective antibiotic therapy 1
- May return to school or work after 24 hours of appropriate antibiotic therapy if fever has resolved and they feel well enough 1
Symptom Management
- Analgesics/antipyretics: Ibuprofen or acetaminophen for pain and fever relief 1
- Hydration: Maintain adequate fluid intake 1
Special Situations
Recurrent Strep Throat
- Evaluate whether patient is experiencing true recurrent infections or is a chronic carrier with viral infections 1
- For recurrent infections, a 5-day decolonization regimen with intranasal mupirocin and daily chlorhexidine washes may be considered 1
Treatment Failure
- Consider treatment failure if symptoms worsen or don't improve after 48-72 hours of antibiotic therapy 1
- Evaluate for penicillin tolerance or other factors that may contribute to treatment failure 4
Diagnostic Approach
- Use Centor Criteria to assess likelihood of GAS pharyngitis 1
- Rapid Antigen Detection Tests (RADTs) should be considered only in patients with high likelihood of streptococcal infections (3-4 Centor criteria) 1
Prevention
- Hand hygiene and avoiding close contact with infected individuals are important preventive measures 1
- Follow-up throat cultures are not routinely indicated for asymptomatic patients who have completed appropriate therapy 1