Strep throat medical therapy: Difference between revisions

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{{Strep throat}}
{{Strep throat}}
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{{CMG}}; {{AE}} {{AA}}


==Overview==
==Overview==
The mainstay of therapy for [[strep throat]] is [[antibiotic]] therapy. Treatment will help reduce symptoms, minimize transmission, and reduce the likelihood of complications.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>


==Treatment==
==Medical therapy==
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]]).
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:<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref><ref name="pmid22965026">{{cite journal| author=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al.| title=Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2012 | volume= 55 | issue= 10 | pages= e86-102 | pmid=22965026 | doi=10.1093/cid/cis629 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22965026 }} </ref>


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>.
{| 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
|-
|}


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


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==
{{WH}}
{{reflist|2}}
{{WS}}


[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Pediatrics]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Pulmonology]]
{{WH}}
{{WS}}

Latest revision as of 00:19, 30 July 2020

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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

The mainstay of therapy for strep throat is antibiotic therapy. Treatment will help reduce symptoms, minimize transmission, and reduce the likelihood of complications.[1]

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:[1][2]

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

  1. ↑ 1.0 1.1 http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016
  2. ↑ Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G; et al. (2012). "Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America". Clin Infect Dis. 55 (10): e86–102. doi:10.1093/cid/cis629. PMID 22965026.


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