From the Guidelines
Strep throat during pregnancy should be treated promptly with antibiotics to prevent complications for both mother and baby, with penicillin being the first-line treatment, typically prescribed as penicillin V 250 mg orally four times daily for 10 days, or amoxicillin 500 mg three times daily for 10 days, as recommended by the Infectious Diseases Society of America 1.
Treatment Options
The following treatment options are available for streptococcal pharyngitis in pregnancy:
- Penicillin V 250 mg orally four times daily for 10 days, or amoxicillin 500 mg three times daily for 10 days, for patients who are not allergic to penicillin 1.
- For penicillin-allergic patients, alternatives include erythromycin, with a dosage that varies with formulation, for 10 days 1, or first-generation cephalosporins, such as cephalexin, with a dosage that varies with the agent, for 10 days 1.
Important Considerations
- Complete the full course of antibiotics even if symptoms improve, to ensure eradication of the bacteria and prevent complications 1.
- Untreated strep throat can lead to serious complications, including rheumatic fever, kidney inflammation, or peripartum infections that could affect the baby 1.
- Symptomatic relief can be achieved with acetaminophen for pain and fever, warm salt water gargles, and plenty of fluids 1.
- Avoid aspirin and most NSAIDs during pregnancy, as they can increase the risk of complications 1.
- Contact your healthcare provider immediately if you develop a rash, difficulty breathing, or if symptoms worsen despite antibiotics 1.
From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy
The treatment options for streptococcal pharyngitis (strep throat) in pregnancy are:
- Penicillin (first-line therapy) for a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease 2
- Azithromycin as an alternative to first-line therapy in individuals who cannot use first-line therapy 3
From the Research
Treatment Options for Streptococcal Pharyngitis in Pregnancy
- The treatment options for streptococcal pharyngitis (strep throat) in pregnancy are similar to those in the general population, with a focus on antibiotic therapy to reduce the risk of complications and transmission to others 4, 5.
- First-line treatment for streptococcal pharyngitis includes a 10-day course of penicillin or amoxicillin, which are considered safe for use during pregnancy 5.
- For patients allergic to penicillin, alternative antibiotics such as first-generation cephalosporins, clindamycin, or macrolide antibiotics may be used 5.
- Macrolide antibiotics, such as clarithromycin, have been shown to be effective in eradicating group A streptococci, with a 10-day course being more effective than a 5-day course of azithromycin 6.
- Antibiotic therapy has been shown to accelerate symptom relief and reduce the risk of locoregional suppuration, but there is no convincing evidence that it reduces the risk of acute glomerulonephritis or relapse 7.
Considerations for Antibiotic Use in Pregnancy
- The use of antibiotics during pregnancy should be guided by a clinical diagnostic score and rapid testing to confirm the presence of group A streptococci, in order to minimize unnecessary antibiotic use and reduce the risk of resistance 7.
- Prenatal antibiotic treatment has not been shown to decrease group B streptococcus colonization at delivery, and therefore should not be used as a substitute for intrapartum antibiotics 8.
- The choice of antibiotic and duration of treatment should be individualized based on the patient's symptoms, medical history, and allergy status, as well as the local incidence of antibiotic-resistant strains 4, 5.