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| |    Treatment of Strep Throat by Dr. Ed Kaplan reviewed by Lynn Cates, M.D., F.A.A.P. Fortunately, strep throat can be treated effectively with antibiotics. The drug of choice is oral penicillin V. The ability of penicillin and its related antibiotics (e.g., amoxicillin) to kill group A streptococci has not changed in more than 50 years. There has never been a group A streptococcus grown from a person that has been resistant to penicillin. Penicillin therapy Usually, penicillin V is given orally (by mouth) two to three times a day for 10 days. Some healthcare providers prefer to use ampicillin or amoxicillin instead of penicillin. Some studies show that amoxicillin given just once a day may work as well as penicillin V given more often. A slight disadvantage of these drugs compared to penicillin is that they are more likely to cause an antibiotic-related rash or diarrhea. Penicillin allergy For patients who are allergic to penicillin, the class of drugs that has been traditionally used are the erythromycins (macrolides); now there are newer, related antibiotics in this class that have been used successfully. Again, the newer forms of the antibiotics are usually more expensive. Duration of oral antibiotic therapy Some new evidence suggests that shorter courses of antibiotic therapy may be as effective in clearing the streptococci from the throat as the traditional 10-day course of oral penicillin, erythromycin, or several other antibiotics. There is controversy about this. The advantage of the shorter course of antibiotics is that children are more likely to receive the full course of treatment; the disadvantage is that the shorter course of therapy might not kill all the group A streptococci in the throat. Penicillin shots Since many children do not receive their full course of oral antibiotic therapy for strep sore throat and tonsillitis, some healthcare providers (and parents) prefer to give a single shot of long-acting penicillin (benzathine penicillin G). This treatment is usually effective, and has been recommended by many physicians' groups because of its one-dose advantage. Pain with the injection has been somewhat of a problem. However, in many situations, the injection, even with transient pain (24 hours or often less), can be an advantage since it ensures complete treatment of the infection. Extremely rarely, the penicillin injection will cause a serious--potentially life-threatening--allergic reaction called anaphylaxis. In order to watch for any signs of allergic reaction, your child's health care provider may suggest that your child to be observed in the office for a period of time after receiving the penicillin shot. Drugs that are not indicated for strep throat The group A streptococcus is one of the few bacteria that remains very sensitive to most antibiotics. There are a number of antibiotics besides penicillin that are effective for treating strep throat. However, these new antibiotics often are more expensive than penicillin. There are two kinds of antibiotics, however, that should not be used to treat strep throat: tetracyclines and sulfonamides. Many strep are resistant to tetracyclines, and sulfonamides do not eliminate strep from the throat (although they can be used to help prevent recurrent rheumatic fever). Treatment of strep throat: what to expect Usually the fever accompanying a strep throat will break and the child will feel better within 48 to 72 hours of beginning antibiotic therapy. In instances when the fever does not return to normal (or almost normal) or the child becomes sicker, you should consult your healthcare provider. Return to school Following therapy with antibiotics, most authorities agree that children usually can return to school 24 hours after their fever is gone. Most often, children return to school within 48 hours after beginning antibiotic therapy. They appear to be less contagious by that time.
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