Strep Throat (cont.)

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Who should be tested for strep throat?

There are no absolute indicators to determine who should be tested for strep throat. However, there are certain predictors that make the possibility of strep tonsillopharyngitis likely. These include:

  1. Children and adolescents between the ages of five and 15
  2. Illness occurring in the late fall, winter, or early spring months
  3. Clinical evidence of acute pharyngitis such as:
  1. Sore throat accompanied by headache or upset stomach that may include nausea and vomiting.
  2. Absence of upper respiratory infection symptoms, such as runny nose, nasal congestion, and cough

Some clinical studies suggest that if all of these points are present, then the likelihood of strep throat may be high. The doctor may decide if testing is necessary based on these or other clinical factors.

How is strep infection treated?

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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.

Antibiotics

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) is the preferred oral form of penicillin for strep throat. A full 10 day course must be completed even though patients usually feel better only after two to three days.

Injectable penicillin G (CR-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) and amoxicillin-clavulanate (Augmentin) are also effective treatments for strep throat. They may be even slightly more effective than penicillin because of better absorption and greater potency. Most pediatricians prefer amoxicillin due to its superior taste and twice-a-day regimen for 10 days.

Cephalosporin antibiotics are also 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:

Other antibiotic options are members of the macrolide family, such as erythromycin (E-Mycin), 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.

Current recommendations still list penicillin or amoxicillin as 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 are alternatives to erythromycin.

It is extremely important to complete the full course of antibiotics when treating strep throat. Most patients experience a rapid reduction in the symptoms and are not contagious after completing their first day of therapy.

Medically Reviewed by a Doctor on 10/16/2014

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