Antibiotic Treatment for Recurrent Strep Throat

Diagnosis and Treatment

A positive throat culture or rapid antigen detection test (RADT) confirms the diagnosis of strep throat, though a negative RADT should be confirmed with a throat culture, as recommended by the Infectious Diseases Society of America 3
The American Academy of Family Physicians recommends clindamycin as the antibiotic therapy for a 101 kg patient with recurrent strep throat infection, at a dose of 300 mg three times daily for 10 days, with strong, high-quality evidence 1, 2
The American Academy of Family Physicians also recommends amoxicillin/clavulanate (Augmentin) as an alternative, at a dose of 875 mg twice daily for 10 days, with strong, moderate-quality evidence 1, 2, 5
Penicillin plus rifampin is another recommended option, with penicillin V 500 mg four times daily for 10 days plus rifampin 600 mg daily for the last 4 days of treatment, and strong, high-quality evidence 1, 2

A full 10-day course is recommended for most antibiotics to achieve maximal pharyngeal eradication of Group A Streptococcus, as recommended by the Infectious Diseases Society of America 3, 1
Azithromycin is the only exception requiring only a 5-day course due to its prolonged tissue half-life, with moderate-quality evidence 1, 4
Complete the full course of antibiotics even if symptoms improve, to prevent complications like rheumatic fever, as recommended by the Infectious Diseases Society of America 3

Routine post-treatment throat cultures are not recommended unless symptoms recur, as recommended by the Infectious Diseases Society of America 3
The patient's weight (101 kg) does not require dose adjustment for most antibiotics, including clindamycin, and the 7-week interval between episodes suggests this is likely a new infection rather than treatment failure, but the previous amoxicillin treatment failure indicates a need for a different antibiotic class 3, 1