From the Guidelines
The treatment of acute pharyngitis (strep throat) in adults typically involves a course of antibiotics, with penicillin V (500 mg orally, 2-3 times daily) or amoxicillin (500-1000 mg orally, 2-3 times daily) being commonly prescribed for a duration of 10 days, as recommended by 1 and 1.
Key Considerations
- For patients with a penicillin allergy, alternative options include azithromycin (500 mg orally on day 1, followed by 250 mg orally daily for 4 days) or clarithromycin (250-500 mg orally, 2 times daily for 10 days) 1.
- Symptomatic relief may be achieved with over-the-counter pain medications such as acetaminophen (650-1000 mg orally, every 4-6 hours) or ibuprofen (200-400 mg orally, every 4-6 hours) 1.
- Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis by rapid antigen detection test and/or culture for group A Streptococcus, and treat patients with antibiotics only if they have confirmed streptococcal pharyngitis 1.
Important Notes
- Antibiotics are not recommended for chronic group A Streptococcus carriers because they are unlikely to spread infection to close contacts and are at little or no risk for complications 1.
- Tonsillectomy solely to reduce the frequency of group A streptococcal pharyngitis in adults is not recommended 1.
- The use of glucocorticoids in conjunction with antibiotic therapy is not routinely recommended for treatment of sore throat, but can be considered in adult patients with more severe presentations 1.
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) 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): Three U. S. Streptococcal Pharyngitis Studies Azithromycin vs. Penicillin V EFFICACY RESULTS Day 14 Day 30 Bacteriologic Eradication: Azithromycin 323/340 (95%) 255/330 (77%) Penicillin V 242/332 (73%) 206/325 (63%) Clinical Success (Cure plus improvement): Azithromycin 336/343 (98%) 310/330 (94%) Penicillin V 284/338 (84%) 241/325 (74%)
The treatment for acute pharyngitis (strep throat) in adults is azithromycin (12 mg/kg once a day for 5 days) or penicillin V (250 mg three times a day for 10 days). Azithromycin has been shown to be clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30.
- Key points:
- Azithromycin: 12 mg/kg once a day for 5 days
- Penicillin V: 250 mg three times a day for 10 days
- Azithromycin is statistically superior to penicillin at Day 14 and Day 30 2
From the Research
Treatment Options for Acute Pharyngitis (Strep Throat) in Adults
The treatment for acute pharyngitis (strep throat) in adults typically involves antibiotics. Some of the treatment options include:
- Azithromycin: A study published in 1991 compared azithromycin with penicillin V for the treatment of streptococcal pharyngitis and found that azithromycin was a safe and effective alternative treatment 3.
- Clarithromycin: A study published in 2003 compared a short-course of clarithromycin with a standard course of penicillin V and found that clarithromycin was equally effective in eradicating S. pyogenes and achieving clinical cure 4.
- Penicillin V: Studies have compared different dosing regimens of penicillin V, including 5-day and 10-day courses, and found that a 5-day course of penicillin V may be as effective as a 10-day course in treating streptococcal pharyngitis 5, 6.
Dosage and Duration of Treatment
The optimal dosage and duration of treatment for acute pharyngitis (strep throat) in adults may vary depending on the antibiotic used. For example:
- Azithromycin: A study published in 2005 found that higher dosages of azithromycin were more effective in treating group A streptococcal tonsillopharyngitis, with a 3-day regimen of 500 mg/day showing a trend favoring azithromycin over 10-day courses of comparators 7.
- Penicillin V: A study published in 2022 found that patients with a Centor Score of 3 or 4 who received penicillin V for 5 days reported earlier recovery and relief from throat pain compared to those who received treatment for 10 days 5.