From the Guidelines
For a sore throat while awaiting strep test results, the best initial treatment includes symptomatic relief with acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours to reduce pain and inflammation, as antibiotics should only be considered if strep is confirmed 1. While awaiting strep test results, it's essential to manage symptoms to improve quality of life.
- Warm salt water gargles (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily can soothe irritation.
- Stay hydrated with cool liquids and consider throat lozenges containing benzocaine or menthol for temporary relief.
- Honey mixed in warm tea or water can coat and soothe the throat naturally.
- Rest your voice and avoid irritants like smoking or alcohol. If strep is confirmed, antibiotics are necessary, and the choice should be based on the most recent and highest quality guidelines, which recommend penicillin or amoxicillin for 10 days for non-allergic patients 1.
- For penicillin-allergic patients, alternatives include a first-generation cephalosporin, clindamycin, clarithromycin, or azithromycin, with specific durations based on the antibiotic chosen 1. It's crucial to note that antibiotics are only beneficial if the sore throat is caused by a bacterial infection, such as streptococcal pharyngitis, and their use should be guided by diagnostic test results to minimize unnecessary antibiotic exposure and promote antibiotic stewardship 1.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever.
The best treatment for a sore throat pending streptococcal (strep) pharyngitis results is penicillin as the first-line therapy. Azithromycin can be used as an alternative in individuals who cannot use first-line therapy 2. It is essential to wait for the streptococcal pharyngitis results to confirm the diagnosis before initiating treatment.
- Key points:
- Penicillin is the usual drug of choice for streptococcal pharyngitis.
- Azithromycin can be used as an alternative in certain cases.
- Treatment should be guided by the results of streptococcal pharyngitis testing.
From the Research
Treatment Options for Sore Throat Pending Strep Pharyngitis Results
- The most effective treatment for streptococcal pharyngitis is still debated, with various antibiotics showing different levels of efficacy 3, 4, 5, 6.
- Penicillin has been the traditional treatment of choice, but its effectiveness has decreased over time, with bacteriologic failure rates ranging from 2 to 30% 3.
- Cephalosporins have been shown to be superior to penicillin in eradicating group A beta-hemolytic Streptococcus, with some studies demonstrating higher cure rates and lower relapse rates 3, 5.
- Macrolides, such as clarithromycin, have also been found to be effective in treating streptococcal pharyngitis, with comparable clinical outcomes to penicillin and higher bacteriologic cure rates 4.
- The choice of antibiotic treatment may depend on various factors, including patient age, allergy history, and clinical presentation 6.
Symptom Management
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective than acetaminophen and placebo in reducing fever and pain associated with streptococcal pharyngitis 6.
- Medicated throat lozenges used every two hours can also provide relief from symptoms 6.
- Corticosteroids may provide a small reduction in symptom duration, but their use is not recommended as a routine treatment 6.
Diagnostic Considerations
- A rapid antigen detection test should be ordered in patients with a modified Centor or FeverPAIN score of 2 or 3 to diagnose streptococcal pharyngitis 6.
- The clinical likelihood of a group A streptococcal infection should be taken into account when making management decisions, with different strategies preferred based on the Centor score 7.