From the Research
Complications of streptococcal pharyngitis in adults are relatively uncommon but can be serious if they occur, with the most significant complications including peritonsillar abscess, rheumatic fever, post-streptococcal glomerulonephritis, and rarely, invasive infections like necrotizing fasciitis. The most recent and highest quality study, 1, provides a comprehensive review of streptococcal pharyngitis, highlighting the importance of early treatment with appropriate antibiotics to reduce the risk of complications. Some key points to consider in the management of streptococcal pharyngitis include:
- The use of clinical decision rules to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 1.
- The recommended treatment is penicillin V 500 mg orally twice daily for 10 days, or amoxicillin 500 mg three times daily for 10 days, with alternatives for penicillin-allergic patients including clindamycin or azithromycin 1, 2.
- Complete adherence to the full antibiotic course is essential to prevent complications, even if symptoms improve quickly 1, 2.
- The potential for suppurative complications like abscesses, which typically develop within 1-2 weeks of infection if inadequately treated, highlights the importance of prompt and effective treatment 1, 2. It is also important to note that the risk of complications can be reduced with early treatment, and that the use of antibiotics with narrow spectrums of activity is preferred to minimize the unnecessary use of antibiotics 3. Overall, the management of streptococcal pharyngitis requires a careful and evidence-based approach to minimize the risk of complications and improve patient outcomes.