What is the treatment for strep throat?

Treatment for Strep Throat

Penicillin V or amoxicillin for 10 days is the first-line treatment for strep throat (Group A β-hemolytic streptococcal pharyngitis), with azithromycin as an alternative for penicillin-allergic patients. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

• Use the Centor Criteria to assess likelihood of Group A Streptococcus (GAS):

  • Fever ≥38°C
  • Absence of cough
  • Tonsillar exudates
  • Anterior cervical lymphadenopathy

• Rapid Antigen Detection Tests (RADTs) should be used in patients with high likelihood of streptococcal infections (3-4 Centor criteria) 1

• Throat culture remains the diagnostic standard and should be used to confirm negative RADT results in children and adolescents 2

First-Line Antibiotic Treatment

For confirmed strep throat, the recommended antibiotics are:

Adults:

• Penicillin V: 250 mg four times daily or 500 mg twice daily for 10 days 1
• Amoxicillin: 500 mg three times daily for 10 days 1

Children:

• Amoxicillin: 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1
• Penicillin V: 600,000 U for <27 kg and 1,200,000 U for ≥27 kg for 10 days 1

Alternative Treatment for Penicillin-Allergic Patients

• Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days 1
• Clindamycin: 300-450 mg orally three times daily for 10 days 1

Important Treatment Considerations

1. Complete the full course: A full 10-day course of penicillin/amoxicillin is essential to prevent rheumatic fever, even if symptoms improve earlier 3, 4

2. Treatment failure awareness: Recent studies show penicillin therapy may be associated with microbiologic failure rates as high as 20%-30%, compared to 5%-10% seen in earlier decades 3

3. Return to school/work: Patients should complete 24 hours of antibiotic therapy before returning to school or work to prevent transmission 5

4. Antibiotic resistance concerns: There is significant resistance to azithromycin and clarithromycin in some parts of the United States 2

5. Follow-up: Patients with worsening symptoms after antibiotic initiation or with symptoms lasting 5 days after starting treatment should be reevaluated 2

Symptomatic Relief

• Ibuprofen or paracetamol (acetaminophen) can be used for pain and fever relief 1
• Corticosteroids are not routinely recommended for symptomatic treatment 1, 2

Complications to Monitor

• Suppurative complications (quinsy, acute otitis media, cervical lymphadenitis, mastoiditis, acute sinusitis) are rare 1
• Non-suppurative complications (acute rheumatic fever, acute glomerulonephritis) are also rare but serious 1

Prevention

• Hand hygiene, avoiding close contact with infected individuals, and not sharing utensils or drinks 1
• Healthcare workers with symptomatic GAS infection should be excluded from work until 24 hours of appropriate treatment and resolution of symptoms 1

Remember that the oral route of administration should not be relied upon in patients with severe illness, nausea, vomiting, or intestinal hypermotility 4. In such cases, intramuscular penicillin may be more appropriate.