From the Guidelines
Strep throat is typically treated with antibiotics, most commonly penicillin or amoxicillin, with the goal of preventing complications like rheumatic fever or kidney inflammation, reducing symptom duration, and preventing spread to others, as supported by the Infectious Diseases Society of America guidelines 1.
Treatment Options
- For adults, the standard treatment is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days.
- For children, the dosage is weight-based, typically amoxicillin 50 mg/kg/day divided into two or three doses for 10 days.
- For those allergic to penicillin, alternatives include azithromycin (500 mg on day 1, then 250 mg daily for 4 more days for adults) or clindamycin (300 mg three times daily for 10 days) 1.
Importance of Completing Antibiotic Course
It's crucial to complete the full course of antibiotics even if symptoms improve before finishing the medication, as this ensures the infection is fully cleared and reduces the risk of complications.
Additional Management Strategies
Alongside antibiotics, rest, increased fluid intake, saltwater gargles, and over-the-counter pain relievers like acetaminophen or ibuprofen can help manage symptoms.
Prevention of Complications
Treating strep throat promptly with antibiotics helps prevent complications like rheumatic fever or kidney inflammation, reduces symptom duration, and prevents spread to others, with patients generally no longer contagious after 24 hours of antibiotic treatment 1.
Special Considerations
For patients who have had a previous episode of rheumatic fever, continuous antimicrobial prophylaxis is necessary to prevent recurrences, with penicillin being the agent of choice for secondary prophylaxis 1.
From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (10-day minimum); otherwise the sequelae of streptococcal disease may occur. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.
The recommended treatment duration for strep infections is a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease. Penicillin is the usual drug of choice for treating Streptococcus pyogenes infections, while azithromycin can be used as an alternative in individuals who cannot use first-line therapy 2 3. Key points to consider when treating strep infections include:
- Using the recommended treatment duration to ensure elimination of the organism
- Selecting the appropriate antibiotic based on the causative organism and its susceptibility
- Performing culture and susceptibility tests to guide antibiotic therapy 2 3.
From the Research
Strep Treatment Options
- Penicillin V is a commonly used treatment for streptococcal pharyngitis, with studies showing its effectiveness in eradicating group A beta-hemolytic streptococci (GABHS) 4, 5, 6, 7, 8
- The duration and frequency of penicillin V treatment can vary, with some studies comparing twice-daily to three-times-daily regimens 4 and others comparing 5-day to 10-day regimens 5, 8
- Alternative treatments, such as clarithromycin and cephalosporins, have also been shown to be effective in treating streptococcal pharyngitis, particularly in patients with penicillin allergy 5, 6, 7
Treatment Efficacy
- Studies have reported varying rates of bacteriological treatment failure with penicillin V, ranging from 18% to 28.5% 4
- Clarithromycin has been shown to be comparable to penicillin V in eradicating S. pyogenes, with a bacteriological eradication rate of 89% 5
- Cephalosporins have been reported to have a lower rate of clinical failure compared to penicillins, but may have drawbacks in terms of cost, administration frequency, and adverse effect profile 7
Treatment Duration and Frequency
- A study comparing 5 days of extended-release clarithromycin to 10 days of penicillin V found that the shorter regimen was equally effective in eradicating S. pyogenes 5
- Another study found that penicillin V four times daily for five days was non-inferior to penicillin V three times daily for 10 days in terms of clinical outcome 8
- The optimal treatment duration and frequency may depend on various factors, including the severity of symptoms, patient age, and antibiotic resistance patterns 6, 7, 8