Because of potential significant complications (described below), if strep throat is detected, it must be treated adequately with antibiotics. It is important to take the full course of antibiotics as prescribed and not to stop the medication when symptoms resolve. Prematurely discontinuing antibiotics can result in the infection being inadequately treated, with potentially adverse consequences or relapse of the infection.
Streptococcus is highly responsive to penicillin and the cephalosporin antibiotics. Penicillin has shown good effectiveness, and it is reliable and cheap.
Oral penicillin V (Pen-Vee-K, Veetids) is the preferred oral form of penicillin for strep throat. The usual dose is 250 milligrams three times a day or 500 milligrams twice a day. A full 10 day course must be completed although patients usually feel better only after two to three days.
Injectable penicillin G (Bicillin) is also very effective and may be used in individuals who may not reliably take 10 days of antibiotics orally. The drug may last in the body for up to 21 days and can therefore adequately treat the infection.
Other penicillin derivatives such as amoxicillin (Amoxil), amoxicillin-clavulanate (Augmentin), cloxacillin (Cloxapen, Tegopen), and dicloxacillin (Dynapen) are all adequate treatments for strep. They may be even slightly more effective than penicillin because of better absorption and greater potency.
Cephalosporin antibiotics are also a very effective in treating group A streptococcus. In some studies, they were found to be better than penicillin, and there is some suggestion that they may be the first choice antibiotic for this infection. For now, they remain a very good choice in patients with mild penicillin allergies.
Some examples of cephalosporin antibiotics used to treat strep throat are:
- cephalexin (Keflex, Keftabs),
- cefadroxil (Duricef),
- cefaclor (Celcor),
- cefixime (Suprax),
- cefprozil (Cefzil),
- cefuroxime axetil (Cefitn),
- loracarbef (Lorabid),
- cefpodoxime (Vantin), and
- cefdinir (Omnicef).
Other options are macrolides, such as erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), azithromycin (Zithromax), and clarithromycin (Biaxin). These antibiotics have shown similar to superior effectiveness compared to penicillin for the treatment of group A streptococcus. Erythromycin is thought to be the optimum choice for people with severe penicillin allergy.
The current recommendations still list penicillin as the first choice for the treatment of group A streptococcus. Erythromycin is recommended as the first choice in penicillin-allergic individuals. First generation cephalosporins such as cephalexin and cefadroxil, are alternatives to erythromycin.
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