Treatment Options for Streptococcal Pharyngitis

Abstract

Group A β-hemolytic streptococcus, the most common bacterial cause of pharyngitis, is susceptible to treatment with penicillins, macrolides, or cephalosporins. Current treatment guidelines recommend narrow-spectrum penicillins as first-choice therapy. Macrolides (erythromycin) and first-generation oral cephalosporins are recommended as suitable alternative therapy for patients who are allergic to penicillin, the former for patients who do not exhibit immediate-type hypersensitivity to β-lactam drugs. These guidelines are somewhat outdated and may not adequately consider advantages offered by other agents. Amoxicillin offers better taste, an important consideration when dealing with pediatric patients. Azithromycin and clarithromycin are generally better-tolerated and preferred over erythromycin, and azithromycin offers a simpler and short-course regimen. Group A β-hemolytic streptococcus resistance to macrolides as a class is a growing problem that should temper their use. Most oral cephalosporins have superior bacteriologic eradication and clinical response compared with narrow-spectrum and broader-spectrum penicillins, and some later-generation cephalosporins are available in simpler once-daily or short-course (5-day) regimens.