Treatment Guidelines for Group A Strep and Group B Strep Infections

Group A Streptococcal (GAS) Infections

• The American Academy of Pediatrics recommends penicillin V as the drug of choice for GAS pharyngitis: 500 mg orally four times daily for 10 days for adults 1, 2
• The Infectious Diseases Society of America suggests amoxicillin (500 mg three times daily for 10 days) as an acceptable alternative, often preferred for children due to better taste of the suspension 1, 2
• The Centers for Disease Control and Prevention prefer intramuscular benzathine penicillin G for patients unlikely to complete a full 10-day oral therapy course 3
• For penicillin-allergic patients, the American College of Physicians recommends erythromycin 2
• The Infectious Diseases Society of America recommends first-generation cephalosporins for patients with non-immediate type hypersensitivity to β-lactams 2
• Clindamycin (300 mg four times daily for 10 days) is recommended for patients with erythromycin-resistant GAS who cannot tolerate β-lactams 2
• Azithromycin (500 mg once daily for 3-5 days) is FDA-approved for a shorter course of therapy 2
• Streptococcal carriers do not ordinarily require antimicrobial therapy, according to the American Academy of Pediatrics 2, 4
• Carriers are at low risk for developing suppurative or non-suppurative complications, as stated by the Infectious Diseases Society of America 2
• For persistent or recurrent GAS colonization, consider clindamycin 300 mg four times daily for 10 days or azithromycin 500 mg once daily for 5 days, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 5, 6
• Healthcare workers with GAS infection should be excluded from clinical work until at least 24 hours of appropriate treatment if asymptomatic, according to the Centers for Disease Control and Prevention 5
• Clearance screens should be taken 24 hours after completing treatment, and again at 1, 3, 6, and 12 weeks, as recommended by the Society for Healthcare Epidemiology of America 6
• For eradication failure, consider screening household contacts and pets as potential sources of reinfection, as suggested by the Infectious Diseases Society of America 6
• Routine testing of asymptomatic household contacts of GAS pharyngitis patients is not recommended except in specific situations with increased risk of frequent infections, according to the American Academy of Pediatrics 1, 7
• Routine post-treatment testing for GAS is not necessary for asymptomatic individuals, as stated by the Infectious Diseases Society of America 2, 7
• For recurrent GAS infections, consider tonsillectomy only for patients whose symptomatic episodes do not diminish in frequency over time, as recommended by the American Academy of Otolaryngology 8