From the Guidelines
Strep pharyngitis in adults is primarily treated with antibiotics, with penicillin being the first-line therapy, as recommended by the most recent guidelines 1.
Treatment Options
The recommended regimen is either penicillin V 500 mg orally twice daily for 10 days or a single intramuscular injection of benzathine penicillin G 1.2 million units.
- For patients with penicillin allergy, alternatives include:
Symptomatic Relief
Symptomatic relief can be achieved with:
- Acetaminophen or ibuprofen for pain and fever
- Salt water gargles for throat discomfort
Importance of Completing Antibiotic Course
Completing the full antibiotic course is essential even if symptoms improve quickly, as this prevents complications like rheumatic fever and reduces transmission 1.
Patient Care
Patients should rest, stay hydrated, and can typically return to work or school after 24 hours of antibiotic therapy when they're no longer contagious. Antibiotics work by eliminating the causative bacteria, Group A Streptococcus, which prevents the immune response that can lead to serious complications. It is crucial to note that the diagnosis of streptococcal pharyngitis should be confirmed by rapid antigen detection test and/or culture for group A Streptococcus before initiating antibiotic therapy 1.
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) Azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates (for the combined evaluable patient with documented GABHS): Three U. S. Streptococcal Pharyngitis Studies Azithromycin vs. Penicillin V EFFICACY RESULTS Day 14Day 30 Bacteriologic Eradication: Azithromycin323/340 (95%)255/330 (77%) Penicillin V242/332 (73%)206/325 (63%) Clinical Success (Cure plus improvement): Azithromycin336/343 (98%)310/330 (94%) Penicillin V284/338 (84%)241/325 (74%)
The treatment for Streptococcal (Strep) pharyngitis in adults is azithromycin (12 mg/kg once a day for 5 days) or penicillin V (250 mg three times a day for 10 days), with azithromycin being clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 2.
- Key points:
- Azithromycin has a bacteriologic eradication rate of 95% at Day 14 and 77% at Day 30.
- Azithromycin has a clinical success rate of 98% at Day 14 and 94% at Day 30.
- Penicillin V has a bacteriologic eradication rate of 73% at Day 14 and 63% at Day 30.
- Penicillin V has a clinical success rate of 84% at Day 14 and 74% at Day 30.
From the Research
Treatment Options for Streptococcal Pharyngitis in Adults
- Penicillin is often recommended as the treatment of choice for group A streptococcal pharyngitis, with a usual dose of 250 mg (400,000 IU) three times daily for 10 days 3
- However, oral penicillin may fail to eradicate group A streptococci from the pharynx in up to 17% of cases, and some studies have reported failure rates as high as 30% 3, 4
- Alternative treatments include:
- Cephalosporins, such as cefpodoxime proxetil, which have been shown to be superior to penicillin in eradicating group A streptococci from the pharynx 3
- Azithromycin, which has been shown to be a safe and effective alternative treatment for streptococcal pharyngitis in adult outpatients 5
- Clarithromycin, which has been shown to be as effective and well-tolerated as penicillin in the treatment of streptococcal pharyngitis 6
Duration of Treatment
- The traditional duration of treatment for streptococcal pharyngitis is 10 days, but some studies have suggested that shorter courses of treatment, such as 5 days, may be effective with certain antibiotics, such as cefpodoxime proxetil 3, 4
- A 5-day course of azithromycin has also been shown to be effective in treating streptococcal pharyngitis 5
Considerations for Treatment
- The choice of treatment should take into account factors such as patient compliance, potential for antibiotic resistance, and the presence of any underlying medical conditions 3, 4, 7
- Cephalosporins may be a useful alternative for patients who have failed penicillin treatment or have a history of recurrent streptococcal pharyngitis 7