What are the approved antibiotic regimens, including course, duration, and dosing, for treating Group A beta-hemolytic streptococcal (GABHS) pharyngitis in pregnancy?

From the Guidelines

Treating Group A beta-hemolytic streptococcal (GABHS) pharyngitis in pregnancy requires penicillin or amoxicillin as the first-line treatment, with a recommended duration of 10 days, as this regimen is likely to eradicate the organism from the pharynx and has a strong, high recommendation based on the evidence from the Infectious Diseases Society of America 1.

Recommended Antibiotic Regimens

The following antibiotic regimens are recommended for treating GABHS pharyngitis in pregnancy:

• Penicillin or amoxicillin for patients non-allergic to these agents, with amoxicillin typically prescribed as 500 mg orally three times daily for 10 days, or alternatively 875 mg twice daily for 10 days.
• For patients with penicillin allergy without anaphylaxis, cephalexin 500 mg orally four times daily for 10 days is recommended.
• In cases of severe penicillin allergy, azithromycin 500 mg orally on day 1, followed by 250 mg daily for days 2-5 can be used, though it has lower efficacy.
• Clindamycin 300 mg orally three times daily for 10 days is another alternative for penicillin-allergic patients.

Importance of Prompt Treatment

Prompt treatment is crucial to prevent complications like rheumatic fever and to reduce transmission. Symptoms typically improve within 24-48 hours of starting antibiotics, but completing the full course is essential to ensure complete eradication of the bacteria.

Supportive Measures

Supportive measures like adequate hydration, rest, and acetaminophen for pain and fever are also recommended during treatment. All these regimens are considered safe during pregnancy and are FDA pregnancy category B medications, meaning they have shown no evidence of risk in animal studies 1.

Key Considerations

Key considerations in treating GABHS pharyngitis in pregnancy include:

• The choice of antibiotic should be based on the patient's allergy history and the severity of the infection.
• The recommended duration of treatment is 10 days to ensure complete eradication of the bacteria.
• Patients should be advised to complete the full course of antibiotics, even if symptoms improve before completion.
• Supportive measures should be used to manage symptoms and prevent complications.

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) The recommended dose of azithromycin for children with pharyngitis/tonsillitis is 12 mg/kg once daily for 5 days.

The approved antibiotic regimen for treating Group A beta-hemolytic streptococcal (GABHS) pharyngitis in pregnancy is not explicitly stated in the provided drug labels for pregnant women. However, for children, the recommended dose is 12 mg/kg once daily for 5 days.

• Azithromycin: 12 mg/kg once daily for 5 days
• Penicillin V: 250 mg three times a day for 10 days No conclusion can be drawn for pregnant women as the information is not provided in the drug labels 2 2.

From the Research

Approved Antibiotic Regimens for GABHS Pharyngitis in Pregnancy

• The approved antibiotic regimens for treating Group A beta-hemolytic streptococcal (GABHS) pharyngitis in pregnancy are not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, the studies suggest that penicillin and other beta-lactam antibiotics are commonly used to treat GABHS infections 3, 7.
• For patients with a penicillin allergy, alternative antibiotics such as cefazolin, vancomycin, and clindamycin may be used 5.
• The American College of Obstetricians and Gynecologists (ACOG) recommends intrapartum antibiotics for GBS positive patients, with penicillin being the drug of choice 5.
• A study comparing different antibiotic treatments for GABHS pharyngitis found that cephalosporins, macrolides, and carbacephem may be effective alternatives to penicillin, but the evidence is uncertain 7.

Course, Duration, and Dosing of Antibiotics

• The studies do not provide specific information on the course, duration, and dosing of antibiotics for treating GABHS pharyngitis in pregnancy.
• However, a study on the treatment of GABHS tonsillopharyngitis found that the duration of treatment varied from 5 to 14 days, depending on the antibiotic used 7.
• Another study found that a single dose of azithromycin was compared to a 10-day course of amoxicillin for treating GABHS pharyngitis in children 7.

Pregnancy Considerations

• The studies highlight the importance of considering pregnancy when treating GABHS pharyngitis, as the risk of complications and the effectiveness of antibiotics may vary in pregnant women 3, 4, 5, 6, 7.
• A study found that intrapartum antibiotic exposure for GBS treatment did not increase the risk of penicillin allergy in children 4.
• Another study found that treating GBS carriers with benzathine penicillin G in the late third trimester eradicated or significantly reduced maternal GBS colonization at delivery 6.