From the Guidelines
Group A streptococcal pharyngitis should be treated with penicillin V 250 mg orally twice daily or 500 mg twice daily for 10 days, or a single intramuscular injection of benzathine penicillin G 1.2 million units, as recommended by the Infectious Diseases Society of America 1. The treatment of Group A streptococcal pharyngitis is crucial to prevent complications such as acute rheumatic fever and post-streptococcal glomerulonephritis.
- The recommended antibiotic regimens for individuals without penicillin allergy include:
- Penicillin V 250 mg orally twice daily or 500 mg twice daily for 10 days
- Amoxicillin 50 mg/kg once daily (max = 1000 mg) for 10 days
- Benzathine penicillin G 1.2 million units intramuscularly for 1 dose
- For individuals with penicillin allergy, alternative options include:
- Cephalexin 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days
- Clindamycin 7 mg/kg/dose three times daily (max = 300 mg/dose) for 10 days
- Azithromycin 12 mg/kg once daily (max = 500 mg) for 5 days It is essential to complete the full 10-day course of antibiotics, even if symptoms resolve earlier, to prevent complications and reduce the risk of transmission to others 1. Symptomatic relief can be achieved with acetaminophen or ibuprofen, warm salt water gargles, and adequate hydration. Patients should stay home from work or school until they've been on antibiotics for at least 24 hours and are no longer febrile. The most recent guidelines from the Infectious Diseases Society of America 1 provide the best evidence for the treatment of Group A streptococcal pharyngitis, and their recommendations should be followed to ensure optimal outcomes.
From the Research
Treatment Options for Group A Streptococcal Pharyngitis
- The recommended first-line therapy for streptococcal pharyngitis is a 10-day course of penicillin V, usually given 2 or 3 times per day 2
- Alternatives to penicillin V include other penicillins, macrolides, and cephalosporins 2
- Cephalosporins may provide somewhat higher bacteriologic eradication rates than penicillin V 2
- A 5-day dosing schedule of certain cephalosporins, such as cefdinir and cefpodoxime proxetil, may increase adherence to the full course of therapy 2
Comparison of Antibiotics
- Clarithromycin was found to be as safe and effective as penicillin V in the treatment of Streptococcus pyogenes throat infections 3
- Penicillin V four times daily for 5 days was non-inferior in clinical outcome to penicillin V three times daily for 10 days 4
- Intense treatment with penicillin V four times a day for 5 days may be clinically beneficial and could be a future treatment strategy for GAS positive pharyngotonsillitis 4
Causes of Penicillin Failure
- Lack of compliance with the 10-day therapeutic regimen is a primary cause of penicillin treatment failure in streptococcal tonsillopharyngitis 5
- Other causes of penicillin treatment failure include reexposure to Streptococcus-infected family members or peers, copathogenicity, antibiotic-associated eradication of normal protective pharyngeal flora, and penicillin tolerance 5
Diagnosis and Treatment Guidelines
- Children who are likely to have GAS pharyngitis based on history or physical examination should have a throat swab and, when positive, be treated with amoxicillin or penicillin 6
- The benefits of antibiotics in treating GAS pharyngitis include preventing acute rheumatic fever and reducing the risk of transmission to close contacts 2, 6