Treatment of Strep Throat

First-Line Treatment Recommendations

The American Academy of Pediatrics and the Infectious Diseases Society of America recommend penicillin or amoxicillin as the first-line treatment for streptococcal pharyngitis due to its proven efficacy, safety, narrow spectrum, and low cost 3, 4
Amoxicillin is equally effective as penicillin and is often preferred for children due to better taste acceptance of the suspension, as recommended by the American Academy of Pediatrics 1, 2
Once-daily amoxicillin (50 mg/kg/day, maximum 1000 mg) for 10 days has been shown to be effective for GAS pharyngitis with improved adherence due to convenient dosing, according to the Infectious Diseases Society of America 1
There has never been a documented case of penicillin-resistant Group A Streptococcus anywhere in the world, as reported by the World Health Organization and the Centers for Disease Control and Prevention 4, 1

The standard treatment duration for GAS pharyngitis is 10 days for most oral antibiotics, including penicillin and amoxicillin, as recommended by the American Academy of Pediatrics and the Infectious Diseases Society of America 3, 1
The Infectious Diseases Society of America notes that while some newer antibiotics have FDA approval for 5-day courses, these shorter regimens with broader-spectrum antibiotics cannot be fully endorsed due to higher cost and broader antimicrobial activity 1, 2

For patients with non-anaphylactic penicillin allergy, the American Academy of Allergy, Asthma, and Immunology recommends first-generation cephalosporins (e.g., cephalexin) for 10 days 1, 6
For patients with immediate hypersensitivity to penicillin, the Infectious Diseases Society of America recommends clindamycin or macrolides (erythromycin, clarithromycin) for 10 days, or azithromycin for 5 days 1, 2

The primary goals of antibiotic treatment are to prevent acute rheumatic fever, prevent suppurative complications, decrease infectivity, and allow rapid return to normal activities, as stated by the American Heart Association 7
The American Academy of Pediatrics recommends intramuscular benzathine penicillin G for patients unlikely to complete a full 10-day course of oral therapy 2

The Infectious Diseases Society of America advises against using broad-spectrum antibiotics like Augmentin as first-line therapy, as it increases costs and promotes antimicrobial resistance without providing additional clinical benefit 1, 2
The Centers for Disease Control and Prevention recommend against using tetracyclines, sulfonamides, and trimethoprim-sulfamethoxazole due to high rates of resistance 1
The American Academy of Pediatrics notes that fluoroquinolones are not recommended due to their broad spectrum and high cost 1
The Infectious Diseases Society of America recommends against routine post-treatment throat cultures or testing of asymptomatic household contacts 2