Strep throat medical therapy: Difference between revisions

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{{Strep throat}}
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==Treatment==
==Overview==
Treatment will reduce symptoms slightly, minimize transmission, and reduce the likelihood of complications. Treatment consists of [[penicillin]] (orally for 10 days; or a single intramuscular injection of penicillin G). [[Erythromycin]] is recommended for penicillin-[[allergy|allergic]] patients. Second-line antibiotics include [[amoxicillin]], [[clindamycin]], and oral [[cephalosporin]]s. Although symptoms subside within 4 days even without treatment, it is very important to start treatment within 10 days of onset of symptoms, and to complete the full course of antibiotics to prevent [[rheumatic fever]], a rare but serious complication.  Other complications that can occur include an [[ear infection]], [[sinus infection]], acute [[glomerulonephritis]], or an abscess on the tonsils ([[peritonsillar abscess]]).
==Medical therapy==
The mainstay of therapy for Strep throat is medical therapy. Treatment will help reduce symptoms, minimize transmission, and reduce the likelihood of complications. Antibiotic treatment recommended for strep throat include the following:


According to a meta-analysis in [[Pediatrics (journal)|Pediatrics]], the overall summary odds ratio (OR) for the bacteriologic cure rate significantly favored cephalosporins compared with penicillin (OR: 3.02; 95% confidence interval [CI]: 2.49 –3.67, with the individual cephalosporins [cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefprozil, cefixime, ceftibuten, and cefdinir] showing superior bacteriologic cure rates).  The overall summary OR for clinical cure rate was 2.33 (95% CI: 1.84 –2.97), significantly favoring cephalosporins. <ref> PMID 15060239 </ref>.


Penicillins should be avoided for treatment of a sore throat if bacterial (swab) confirmation has not been obtained since it causes a distinctive rash if the true illness proves to be viral. This rash is harmless but alarming. The most common virus illness responsible for strep-like symptoms is [[glandular fever]], also known as [[mononucleosis]]. Typically, antibiotics such as [[clindamycin]] or [[clarithromycin]] will be prescribed if there is any doubt as to whether the infection is bacterial as it does not cause a rash in the presence of a virus.
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''For individuals without penicillin allergy'''}}
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Drug, Route}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Recommended dose}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Duration}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Penicillin V, oral'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Children: 250 mg twice daily or 3 times daily; adolescents and adults: 250 mg 4 times daily or 500 mg twice daily
| style="padding: 5px 5px; background: #F5F5F5;" |
*10 days
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Amoxicillin, oral'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*50 mg/kg once daily (max = 1000 mg);
*Alternate:25 mg/kg (max = 500 mg) twice daily
| style="padding: 5px 5px; background: #F5F5F5;" |
*10 days
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Benzathine penicillin G, intramuscular'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*<27 kg: 600 000 U; ≥27 kg: 1 200 000 U
| style="padding: 5px 5px; background: #F5F5F5;" |
*1 dose
|-
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''For individuals with penicillin allergy'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cephalexin, oral'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*20 mg/kg/dose twice daily (max = 500 mg/dose)
| style="padding: 5px 5px; background: #F5F5F5;" |
*10 days
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cefadroxil, oral'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*30 mg/kg once daily (max = 1 g)
| style="padding: 5px 5px; background: #F5F5F5;" |
*10 days
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Clindamycin, oral'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*7 mg/kg/dose 3 times daily (max = 300 mg/dose)
| style="padding: 5px 5px; background: #F5F5F5;" |
*10 days
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Azithromycin, oral'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*12 mg/kg once daily (max = 500 mg)
| style="padding: 5px 5px; background: #F5F5F5;" |
*5 days
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Clarithromycin, oral'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*7.5 mg/kg/dose twice daily (max = 250 mg/dose)
| style="padding: 5px 5px; background: #F5F5F5;" |
*10 days
|-
|}


In addition to taking antibiotics, other ways to relieve strep symptoms include taking nonprescription medications (such as [[ibuprofen]] and [[acetaminophen]]/[[paracetamol]]) for throat pain and fever reduction, and getting plenty of rest.  Also, gargling with warm saltwater (1/4 teaspoon of table salt in 8 oz. warm water) can help relieve throat pain as well as warm, plain tea.  Avoid orange juice or other citrus drinks. The acids in them may irritate the throat.


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Otolaryngology]]
[[Category:Pulmonology]]
[[Category:Primary care]]
[[Category:Bacterial diseases]]


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Revision as of 19:42, 18 October 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Medical therapy

The mainstay of therapy for Strep throat is medical therapy. Treatment will help reduce symptoms, minimize transmission, and reduce the likelihood of complications. Antibiotic treatment recommended for strep throat include the following:


For individuals without penicillin allergy
Drug, Route Recommended dose Duration
Penicillin V, oral
  • Children: 250 mg twice daily or 3 times daily; adolescents and adults: 250 mg 4 times daily or 500 mg twice daily
  • 10 days
Amoxicillin, oral
  • 50 mg/kg once daily (max = 1000 mg);
  • Alternate:25 mg/kg (max = 500 mg) twice daily
  • 10 days
Benzathine penicillin G, intramuscular
  • <27 kg: 600 000 U; ≥27 kg: 1 200 000 U
  • 1 dose
For individuals with penicillin allergy
Cephalexin, oral
  • 20 mg/kg/dose twice daily (max = 500 mg/dose)
  • 10 days
Cefadroxil, oral
  • 30 mg/kg once daily (max = 1 g)
  • 10 days
Clindamycin, oral
  • 7 mg/kg/dose 3 times daily (max = 300 mg/dose)
  • 10 days
Azithromycin, oral
  • 12 mg/kg once daily (max = 500 mg)
  • 5 days
Clarithromycin, oral
  • 7.5 mg/kg/dose twice daily (max = 250 mg/dose)
  • 10 days


References


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