From the Guidelines
No, 100mg twice daily doxycycline is not the appropriate treatment for strep throat. The recommended first-line treatment for strep throat (Group A Streptococcal pharyngitis) is penicillin, specifically penicillin V 250 mg orally four times daily or 500 mg twice daily for 10 days, or amoxicillin 50 mg/kg once daily (max = 1000 mg) for 10 days 1. For patients with penicillin allergy, appropriate alternatives include cephalexin 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days (if not anaphylactic to penicillin) or, in cases of severe penicillin allergy, clindamycin 7 mg/kg/dose three times daily (max = 300 mg/dose) for 10 days or azithromycin 12 mg/kg once daily (max = 500 mg) for 5 days 1. Doxycycline is not recommended because Group A Streptococcus has shown increasing resistance to tetracyclines, and clinical studies have demonstrated lower eradication rates compared to beta-lactam antibiotics.
Key Considerations
- The treatment of strep throat is crucial to prevent complications such as rheumatic fever and post-streptococcal glomerulonephritis.
- The choice of antibiotic should be based on the patient's allergy history and the local resistance patterns.
- Penicillin and amoxicillin are the preferred first-line treatments due to their high efficacy and safety profile.
- Alternative treatments, such as cephalexin, clindamycin, and azithromycin, should be used in patients with penicillin allergy.
Treatment Options
- Penicillin V: 250 mg orally four times daily or 500 mg twice daily for 10 days
- Amoxicillin: 50 mg/kg once daily (max = 1000 mg) for 10 days
- Cephalexin: 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days
- Clindamycin: 7 mg/kg/dose three times daily (max = 300 mg/dose) for 10 days
- Azithromycin: 12 mg/kg once daily (max = 500 mg) for 5 days It is essential to note that doxycycline is not a recommended treatment for strep throat due to the increasing resistance of Group A Streptococcus to tetracyclines and the potential side effects, such as photosensitivity, and its contraindication in children under 8 years and pregnant women 1.
From the FDA Drug Label
When used in streptococcal infections, therapy should be continued for 10 days Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day In the management of more severe infections (particularly chronic infections of the urinary tract), 100 mg every 12 hours is recommended
The dose of 100mg b.d. (twice daily) doxycycline is appropriate for the treatment of strep throat in adults, as it is within the recommended dosage for more severe infections, and the therapy should be continued for 10 days 2.
From the Research
Treatment Options for Strep Throat
- The recommended first-line therapy for streptococcal pharyngitis is a 10-day course of penicillin V, usually given 2 or 3 times per day 3.
- Alternatives to penicillin V include other penicillins, macrolides, and cephalosporins 3.
- Amoxicillin is equally effective as penicillin and more palatable 4.
- Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy 4.
Use of Doxycycline for Strep Throat
- There is no mention of doxycycline as a recommended treatment for strep throat in the provided studies 3, 4, 5, 6, 7.
- The studies recommend penicillin, amoxicillin, and first-generation cephalosporins as treatment options for strep throat 3, 4, 5, 7.
- Doxycycline is not listed as a suitable alternative for the treatment of strep throat in any of the provided studies.
Dosage and Administration
- The recommended dosage and administration of antibiotics for strep throat vary depending on the specific antibiotic and patient factors 3, 4, 5.
- A 10-day course of antibiotics is typically recommended for the treatment of strep throat 3, 4, 5.
- There is no evidence to support the use of 100mg b.d. doxycycline as a treatment for strep throat 3, 4, 5, 6, 7.