What is the supportive treatment for Streptococcal (Strep) pharyngitis?

From the Guidelines

Supportive treatment for strep pharyngitis focuses on relieving symptoms while antibiotics work to eliminate the bacterial infection, and the most effective approach includes a combination of over-the-counter pain relievers, hydration, and throat soothing measures. The treatment of strep pharyngitis should prioritize the use of antibiotics, such as penicillin or amoxicillin, for 10 days, as recommended by the Infectious Diseases Society of America 1.

Key Supportive Measures

• Over-the-counter pain relievers such as acetaminophen (325-650 mg every 4-6 hours, not exceeding 3000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) can reduce throat pain and fever.
• Gargling with warm salt water (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily helps soothe the throat by reducing inflammation and loosening mucus.
• Adequate hydration is essential, aiming for at least 8-10 glasses of water daily, while avoiding irritating beverages like alcohol or acidic juices.
• Throat lozenges containing benzocaine or menthol can provide temporary numbing relief.
• Using a humidifier adds moisture to the air, preventing further throat irritation.
• Rest is crucial to support the immune system's fight against infection.
• Consuming soft, cool foods like yogurt, smoothies, and popsicles minimizes swallowing discomfort. These supportive measures work by reducing inflammation, providing pain relief, and creating an environment conducive to healing while the prescribed antibiotics address the underlying Streptococcus pyogenes infection, as noted in the clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America 1.

From the FDA Drug Label

In some infections, therapy may be required for several weeks. It may be necessary to continue clinical and/or bacteriological follow-up for several months after cessation of therapy. It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever.

The supportive treatment for Streptococcal (Strep) pharyngitis includes at least 10 days of antibiotic treatment with a drug such as amoxicillin or penicillin to prevent the occurrence of acute rheumatic fever.

• The treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained.
• Clinical and/or bacteriological follow-up may be necessary for several months after cessation of therapy 2.
• Patients should be counseled to take the medication exactly as directed and to complete the full course of therapy to decrease the effectiveness of the immediate treatment and increase the likelihood that bacteria will develop resistance 3.

From the Research

Supportive Treatment for Streptococcal Pharyngitis

The supportive treatment for Streptococcal pharyngitis includes:

• Antibiotic therapy, with penicillin being the first-line treatment 4, 5, 6, 7, 8
• Pain management using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen 8
• Medicated throat lozenges used every two hours to help alleviate symptoms 8
• Corticosteroids may be used in some cases, but they are not recommended for routine use due to their limited benefit in reducing symptom duration 8

Antibiotic Treatment Options

The following antibiotic treatment options are available for Streptococcal pharyngitis:

• Penicillin V given in two daily doses 7
• Amoxicillin as a 10-day course 8
• First-generation cephalosporins, clindamycin, or macrolide antibiotics for patients allergic to penicillin 8
• Cephalosporins, which have been shown to be effective in eradicating group A beta-hemolytic Streptococcus, especially in cases of recurrent streptococcal tonsillopharyngitis 4, 6

Important Considerations

• The diagnosis of Streptococcal pharyngitis should be based on microbiological testing, clinical algorithm, or a combination of both 5
• The treatment of choice for Streptococcal pharyngitis is penicillin, but other antibiotics such as cephalosporins may be preferable in some cases 4, 6
• The differentiation between GAS pharyngitis and viral pharyngitis is crucial to minimize unnecessary antibiotic prescriptions 5