From the Guidelines
Penicillin is the first-line antibiotic for beta-hemolytic streptococci infections, with oral penicillin V 500 mg twice daily for 10 days being the recommended treatment for adults with streptococcal pharyngitis. This recommendation is based on the most recent and highest quality study available, which confirms that penicillin is effective in treating group A streptococcal pharyngitis and preventing complications such as rheumatic fever 1. The study also notes that beta-hemolytic streptococci, particularly Group A (Streptococcus pyogenes), remain universally susceptible to penicillin, which works by inhibiting bacterial cell wall synthesis.
Some key points to consider when treating beta-hemolytic streptococci infections include:
- The importance of complete treatment to prevent complications like rheumatic fever or post-streptococcal glomerulonephritis
- The use of alternative antibiotics, such as macrolides like azithromycin or clindamycin, for patients with penicillin allergy
- The consideration of testing household members who may be asymptomatic carriers in cases of recurrent infections
- The fact that antimicrobial resistance has not been a significant issue in the treatment of group A streptococcal pharyngitis in the United States, with no clinical isolate of group A Streptococcus anywhere in the world documented to be resistant to penicillin 1
It's also worth noting that the American Heart Association recommends penicillin as the treatment of choice for group A streptococcal pharyngitis, due to its cost-effectiveness, narrow spectrum of activity, and long-standing proven efficacy 1. Overall, the evidence suggests that penicillin is the most effective and recommended antibiotic for treating beta-hemolytic streptococci infections.
From the FDA Drug Label
In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes)
Approximately 1% of azithromycin-susceptible S pyogenes isolates were resistant to azithromycin following therapy.
In cases of β-hemolytic streptococcal infections, treatment should continue for at least 10 days.
The recommended antibiotic for Beta-Hemolytic Streptococci (BHS) infection is penicillin V or azithromycin.
- Azithromycin is given at a dose of 12 mg/kg once a day for 5 days.
- Penicillin V is given at a dose of 250 mg three times a day for 10 days. Treatment should continue for at least 10 days 2, 3.
From the Research
Recommended Antibiotics for Beta-Hemolytic Streptococci (BHS) Infection
- Penicillin is currently recommended by the American Academy of Pediatrics and American Heart Association as first-line therapy for GABHS infections 4
- Erythromycin is recommended for those allergic to penicillin 4
- Cephalosporins or azithromycin are preferred following penicillin treatment failures in selected patients as first-line therapy, based on a history of penicillin failures or lack of compliance and for impetigo 4
- Clindamycin administration may improve outcomes in patients with serious streptococcal infections, and its use in combination with benzylpenicillin has been shown to be of benefit 5, 6
- The use of intravenous immunoglobulin is suggested in STSS in combination with antibiotics and surgery 6
Treatment Duration and Route
- Treatment duration with penicillin should be 10 days to optimize cure in GABHS infections 4
- A 5-day regimen is possible and approved by the United States Food and Drug Administration for cefpodoxime (a cephalosporin) and azithromycin (a macrolide) 4
- Intravenous antibiotics may be superior to oral antibiotics for the treatment of beta-hemolytic streptococcal BSI, particularly in patients with severe infections 7