From the Guidelines
Not treating strep throat in adults can lead to serious complications, including rheumatic fever, post-streptococcal glomerulonephritis, and other risks such as peritonsillar abscess, sinusitis, and ear infections. Untreated streptococcal infections can progress to these complications, which can have a significant impact on morbidity, mortality, and quality of life 1. The standard treatment for strep throat in adults is penicillin V (500 mg twice daily for 10 days) or amoxicillin (500 mg twice daily for 10 days), as recommended by the Infectious Diseases Society of America 1. For penicillin-allergic patients, 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. It's crucial to complete the full course of antibiotics even if symptoms improve quickly, as treatment not only prevents complications but also reduces contagiousness after 24 hours of antibiotics 1.
Some key points to consider when treating strep throat in adults include:
- The importance of accurate diagnosis, as clinical scoring systems can be useful in predicting the likelihood of streptococcal infection, but laboratory confirmation is essential in making a precise diagnosis 1
- The need to avoid unnecessary antibiotic use, as many cases of pharyngitis are caused by viral infections and do not require antibiotic treatment 1
- The importance of selective use of diagnostic studies for GAS, to avoid identifying carriers rather than acutely infected individuals 1
Overall, prompt and appropriate treatment of strep throat in adults is essential to prevent complications and reduce the risk of transmission to others. By following the recommended treatment guidelines and completing the full course of antibiotics, adults with strep throat can reduce their risk of serious complications and improve their quality of life 1.
From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur.
The risk of not treating strep in adults includes the potential development of sequelae of streptococcal disease if the organism is not eliminated.
- Therapy must be sufficient to eliminate the organism, with a minimum duration of ten days. It is essential to complete the full course of therapy as directed to prevent decreased effectiveness and increased likelihood of bacterial resistance 2.
From the Research
Risks of Not Treating Strep in Adults
- Not treating strep throat in adults can lead to complications such as acute rheumatic fever (ARF) and acute post-streptococcal glomerulonephritis (APSGN) 3, 4
- These complications can occur even in adults, and it is essential to have a high clinical suspicion for the sequela of Group A beta-hemolytic Streptococcus (GABHS) infection in the setting of cardiac and renal disease following upper respiratory infection (URI) symptoms 3
- Untreated strep throat can also lead to post-streptococcal reactive arthritis (PSRA), a condition characterized by inflammatory arthritis associated with a recent group A streptococcal infection 5
- The risk of developing these complications highlights the importance of accurate diagnosis and treatment of strep throat in adults, using methods such as throat culture or rapid antigen detection testing 6, 7
Potential Consequences of Untreated Strep Throat
- Acute rheumatic fever (ARF) can lead to rheumatic heart disease, which can result in long-term cardiac damage 4
- Acute post-streptococcal glomerulonephritis (APSGN) can cause kidney damage and lead to hypertension and generalized edema 4
- Post-streptococcal reactive arthritis (PSRA) can cause prolonged or recurrent arthritis, and may be associated with extraarticular manifestations such as erythema nodosum, uveitis, and glomerulonephritis 5
- Untreated strep throat can also lead to chronic GABHS colonization, which can increase the risk of transmitting the disease to others 6