From the Guidelines
If you've recently been treated for strep throat with penicillin (PCN) but are experiencing symptoms again, you should see your healthcare provider for evaluation, as they may prescribe a different antibiotic such as amoxicillin-clavulanic acid (40 mg amoxicillin/kg/d in 3 doses for 10 days) or clindamycin (20–30 mg/kg/d in 3 doses for 10 days) to address potential resistance or recurrence 1. This change in antibiotic is crucial because your infection might be resistant to penicillin or you might be experiencing a recurrence rather than treatment failure. Your doctor may also take another throat culture to confirm strep is still present. In some cases of frequent recurrences, your provider might consider testing family members who could be asymptomatic carriers, or in rare situations, might discuss tonsillectomy if you have had multiple documented infections. It's essential to complete the full course of any prescribed antibiotics, even if you feel better, to ensure the infection is completely eliminated and to prevent complications like rheumatic fever. Some key points to consider include:
- The choice of antibiotic should be based on the severity of symptoms, patient age, and potential allergies or resistance patterns 1.
- Amoxicillin-clavulanic acid and clindamycin are effective alternatives for patients who have recently been treated with penicillin 1.
- Tonsillectomy may be considered in rare cases of frequent recurrences, but this decision should be made on a case-by-case basis, taking into account the patient's overall health and medical history 1.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy 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.
The treatment for strep throat if recently treated for strep throat with penicillin (pcn) is azithromycin as an alternative to first-line therapy in individuals who cannot use first-line therapy.
- Key points:
- Azithromycin can be used to treat pharyngitis/tonsillitis caused by Streptococcus pyogenes.
- Penicillin is the usual drug of choice, but azithromycin can be used as an alternative in individuals who cannot use first-line therapy.
- Susceptibility tests should be performed to ensure the bacteria are susceptible to azithromycin 2.
From the Research
Treatment for Strep Throat
If a patient has recently been treated for strep throat with penicillin (PCN), the following points should be considered:
- The treatment of choice for strep throat is penicillin, due to its cost, narrow spectrum of activity, and effectiveness 3.
- Amoxicillin is equally effective and more palatable than penicillin 3.
- If the patient has a penicillin allergy, erythromycin and first-generation cephalosporins are alternative options 3.
- However, there is evidence of increased group A beta-hemolytic streptococcus (GABHS) treatment failure with penicillin, and some advocate for the use of cephalosporins in all non-allergic patients due to better GABHS eradication and effectiveness against chronic GABHS carriage 3.
- The decision to treat with antibiotics should be based on a careful physical examination, patient history, and diagnostic methods such as rapid antigen detection tests or throat culture 4.
- Clinical guidelines can help medical professionals choose among available techniques to diagnose and treat strep throat, but there is substantial evidence that most physicians do not follow any published guidelines 4.
Considerations for Recent Treatment
- If the patient has recently been treated for strep throat with PCN, it is essential to consider the possibility of treatment failure or recurrent infection 3.
- The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 3.
- Chronic GABHS colonization is common despite appropriate use of antibiotic therapy, and chronic carriers are at low risk of transmitting disease or developing invasive GABHS infections 3.