From the Guidelines
Strep pharyngitis should be treated with a 10-day course of oral penicillin V or amoxicillin, as these antibiotics have been shown to effectively eradicate the Group A Streptococcus bacteria from the pharynx and prevent complications such as rheumatic fever and kidney inflammation 1. The treatment of strep pharyngitis typically involves the use of antibiotics, with penicillin V and amoxicillin being the preferred choices due to their narrow spectrum of activity, low frequency of adverse reactions, and moderate cost.
- For patients who are not allergic to penicillin, the recommended dosage is 250-500 mg of penicillin V twice daily for adults, or 250 mg 2-3 times daily for children, or 500 mg of amoxicillin twice daily for adults, or 50 mg/kg/day divided into two doses for children.
- For patients who are allergic to penicillin, alternative antibiotics such as azithromycin, clindamycin, or a first-generation cephalosporin can be used, with the specific regimen depending on the severity of the allergy and the patient's medical history. It is essential to complete the full antibiotic course, even if symptoms improve, to ensure that the infection is fully cleared and to prevent the development of complications.
- Supportive care, including the use of analgesics such as acetaminophen or ibuprofen, warm salt water gargles, and adequate hydration, can help to alleviate symptoms and improve patient comfort.
- Patients can typically return to school or work 24 hours after starting antibiotics, as they are no longer contagious at this point. The diagnosis of strep pharyngitis should be confirmed through testing, such as a rapid strep test or throat culture, to ensure that the patient receives the appropriate treatment and to prevent the overuse of antibiotics 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. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.
Strep Pharyngitis Treatment:
- The recommended treatment for strep pharyngitis with penicillin (PO) is a ten-day minimum course to eliminate the organism and prevent sequelae of streptococcal disease 2.
- Azithromycin (PO) can be used as an alternative to first-line therapy in individuals who cannot use first-line therapy for pharyngitis/tonsillitis caused by Streptococcus pyogenes 3.
From the Research
Diagnosis of Strep Pharyngitis
- Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4 degrees F (38 degrees C), tonsillar exudates, and cervical adenopathy 4
- Available diagnostic tests include throat culture and rapid antigen detection testing, with throat culture considered the diagnostic standard 4
- 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 4, 5
Treatment of Strep Pharyngitis
- Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice because of cost, narrow spectrum of activity, and effectiveness 4
- Amoxicillin is equally effective and more palatable 4, 6
- Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy 4, 7
- Azithromycin is not recommended due to significant resistance in some parts of the United States 6 and lower bacteriologic eradication rates compared to penicillin V 8
Management and Prevention
- Chronic group A beta-hemolytic streptococcus (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 4
- Tonsillectomy is rarely recommended as a preventive measure, with specific thresholds for considering surgery 6
- Nonsteroidal anti-inflammatory drugs and medicated throat lozenges can be used to treat fever and pain associated with GABHS pharyngitis, while corticosteroids are not recommended for routine use 5