From the Guidelines
I strongly recommend seeking immediate medical attention for the persistent strep throat infection that hasn't responded to previous antibiotics, as the recurring positive strep tests, worsening shortness of breath, and continued throat irritation despite taking azithromycin and clindamycin suggest either antibiotic resistance or a complication developing. The patient's symptoms, such as increased shortness of breath and irritated throat, are concerning and may indicate the infection is spreading or causing inflammatory reactions affecting the airways 1.
Given the patient's history of taking azithromycin and clindamycin without improvement, it is essential to consider alternative antibiotic regimens. According to the Infectious Diseases Society of America guidelines, penicillin or amoxicillin are first-line treatments for strep throat if the patient is not allergic 1. The guidelines also recommend that for individuals with penicillin allergy, cephalexin or cefadroxil can be used as alternative treatments 1.
The patient's doctor may need to collect another throat culture to determine which antibiotics would be most effective against their specific strain of Streptococcus bacteria. In the meantime, it is crucial to manage symptoms, such as staying hydrated, resting the voice, using throat lozenges for comfort, and taking acetaminophen or ibuprofen for pain and inflammation.
Untreated or inadequately treated strep infections can lead to serious complications, including rheumatic fever, kidney inflammation, or peritonsillar abscess, which is why proper treatment is essential 1. The guidelines emphasize the importance of accurate diagnosis and appropriate antimicrobial therapy to prevent these complications and improve clinical symptoms and signs 1.
In cases where the patient experiences multiple episodes of acute pharyngitis with laboratory confirmation of GAS, it is likely that the patient is a chronic streptococcal carrier experiencing repeated viral infections 1. However, in this scenario, the patient's worsening symptoms and lack of response to previous antibiotics suggest the need for immediate medical attention to determine the best course of treatment.
From the Research
Treatment of Streptococcal Infections
- The patient has taken azithromycin and clindamycin, but still experiences repeated positive strep swabs, increased shortness of breath, and an irritated throat 2, 3, 4.
- Studies have shown that amoxicillin-clavulanic acid is effective in treating streptococcal infections, including those caused by beta-lactamase-producing organisms 5, 6.
- Amoxicillin-clavulanic acid has been shown to be more effective than amoxicillin alone in eliminating Streptococcus pyogenes from mixed infections with Staphylococcus aureus 5.
Antibiotic Resistance and Treatment
- The emergence of antibiotic-resistant strains of Streptococcus pneumoniae and other bacteria has led to the development of new, high-dose formulations of amoxicillin-clavulanic acid 3.
- Clarithromycin has been shown to be less effective than amoxicillin-clavulanic acid in eradicating Streptococcus pyogenes, particularly in areas with high levels of clarithromycin resistance 4.
- The use of amoxicillin-clavulanic acid should be guided by epidemiological and pharmacokinetic data, and the choice of combination ratio should be based on available evidence 6.
Clinical Efficacy and Safety
- Amoxicillin-clavulanic acid has been shown to have high therapeutic efficacy and a favorable safety profile in the treatment of acute streptococcal tonsillopharyngitis 2.
- The incidence of adverse reactions with amoxicillin-clavulanic acid is generally lower than with other antibiotics, such as clarithromycin 4.
- The safety and efficacy of amoxicillin-clavulanic acid in pediatric patients have been established, and it is recommended for use in children with acute otitis media and other respiratory tract infections 3, 4.