What are the next steps for treating streptococcal pharyngitis after a course of Augmentin (amoxicillin-clavulanate)?

From the Guidelines

For strep throat that persists after a course of Augmentin (amoxicillin-clavulanate), a different antibiotic should be prescribed, with options including clindamycin, penicillin and rifampin, or intramuscular benzathine penicillin G, as recommended by the Infectious Diseases Society of America 1. When considering treatment for strep throat that has not responded to an initial course of Augmentin, it's crucial to select an antibiotic regimen that is effective against Group A Streptococcus (GAS) and suitable for the patient's specific situation.

• The choice of antibiotic should be based on factors such as the patient's allergy history, potential side effects, and the likelihood of adherence to the prescribed regimen.
• Clindamycin is a viable option, given its strong recommendation and high quality of evidence for treating GAS pharyngitis, especially in cases where first-line treatments have failed 1.
• Penicillin and rifampin combination therapy is also a strong, high-quality recommendation for eradicating GAS carriage, particularly in scenarios where there's a need to ensure the bacteria are fully eliminated 1.
• Intramuscular benzathine penicillin G is another option, especially when there are concerns about adherence to oral antibiotic regimens, as it provides a long-acting alternative with a strong, high recommendation for treating GAS pharyngitis 1. It's also important to note that treatment failure may not always be due to antibiotic resistance but could be a result of poor adherence to the medication regimen, a viral co-infection, or post-streptococcal inflammation rather than an active bacterial infection.
• Completing the full course of antibiotics, even if symptoms improve, is crucial to ensure the infection is fully cleared and to prevent potential complications.
• If symptoms persist after a second course of antibiotics, further evaluation may be necessary to rule out complications or to determine if the patient is a carrier of GAS, which might require a different management approach 1. Supportive care measures, including rest, hydration, saltwater gargles, and over-the-counter pain relievers, can help manage symptoms during the recovery period.
• The decision to use any of these treatments should be guided by the most recent and highest-quality evidence available, prioritizing the patient's morbidity, mortality, and quality of life outcomes 1.

From the FDA Drug Label

It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained

The treatment of strep throat after an Augmentin course is not directly addressed, but amoxicillin can be used to treat strep throat.

• The recommended duration of treatment for strep throat is at least 10 days to prevent acute rheumatic fever.
• Treatment should be continued for a minimum of 48 to 72 hours beyond the time the patient becomes asymptomatic or evidence of bacterial eradication is obtained 2

From the Research

Treatment of Strep Throat After Augmentin Course

• The treatment of strep throat typically involves a 10-day course of antibiotics, such as penicillin or amoxicillin 3, 4, 5.
• Augmentin, a combination of amoxicillin and clavulanate, is also used to treat strep throat, but its effectiveness may vary depending on the patient's condition and the severity of the infection.
• If a patient has completed a course of Augmentin and still experiences symptoms, it is essential to reevaluate the patient to determine the best course of action 5.
• In some cases, a second course of antibiotics may be necessary, but this should be determined by a healthcare professional based on the patient's specific condition and test results.

Diagnostic Methods and Clinical Guidelines

• Diagnostic methods for strep throat include throat culture, rapid antigen detection tests, and clinical scoring systems 6, 7.
• Clinical guidelines recommend using these diagnostic methods to confirm the presence of group A beta-hemolytic streptococcus (GABHS) before prescribing antibiotics 3, 5.
• The American and European professional associations have developed guidelines for diagnosing and treating strep throat, but there is significant variation in these guidelines, and many physicians do not follow them 6.

Antibiotic Treatment and Resistance

• Antibiotics with narrow spectrums of activity, such as penicillin and amoxicillin, are recommended for treating strep throat 3, 4, 5.
• However, there is significant resistance to some antibiotics, such as azithromycin and clarithromycin, in some parts of the United States 5.
• First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 5.