From the Guidelines
Strep throat should be treated with antibiotics, specifically penicillin or amoxicillin, for a duration of 10 days to eradicate the infecting organism and prevent complications. The standard treatment for adults is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days 1. For children, the dosage is weight-based, usually 250-500 mg of amoxicillin twice daily for 10 days 1. For those allergic to penicillin, alternatives include azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) or clindamycin (300 mg three times daily for 10 days) 1. Some key points to consider when treating strep throat include:
- Completing the full course of antibiotics even if symptoms improve before finishing the medication
- Using over-the-counter pain relievers like acetaminophen or ibuprofen to manage throat pain and fever
- Gargling with warm salt water and drinking plenty of fluids to provide relief
- The importance of antibiotics in preventing serious complications like rheumatic fever or kidney inflammation that can occur when strep infections go untreated 1. It's also important to note that antibiotics should only be prescribed for patients with confirmed streptococcal pharyngitis, and that testing with a rapid antigen detection test and/or culture for group A Streptococcus should be performed to confirm the diagnosis 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 Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx 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)
Azithromycin is effective in treating strep throat. The clinical success rate for azithromycin in treating pharyngitis/tonsillitis caused by Streptococcus pyogenes was 98% at Day 14 and 94% at Day 30, with bacteriologic efficacy rates of 95% at Day 14 and 77% at Day 30 2.
From the Research
Strep Throat Treatment Overview
- Strep throat, or group A beta-hemolytic streptococcal pharyngitis, is a common infection that affects millions of people in the United States annually 3.
- The diagnosis of strep throat can be made using clinical decision rules, rapid antigen testing, and throat culture 3, 4.
Diagnostic Tests
- Throat culture is considered the diagnostic standard, although rapid antigen detection testing has improved significantly in terms of sensitivity and specificity 4.
- The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 4.
Treatment Options
- Penicillin and amoxicillin are first-line antibiotics for the treatment of strep throat, with a recommended course of 10 days 3, 4, 5.
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 3, 4.
- Azithromycin and clarithromycin are not recommended due to significant resistance in some parts of the United States 3.
- A 3-day course of azithromycin has been shown to have similar clinical efficacy to a 10-day course of penicillin V, but with lower bacteriologic eradication rates 6.
Treatment Outcomes
- There is insufficient evidence to show clinically meaningful differences between antibiotics for group A beta hemolytic streptococci tonsillopharyngitis 5.
- Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 3.