Antibiotics are rarely indicated, most infections are viral and bacterial infections are usually self-limiting. Rheumatic fever is very rare.
The following are more likely in Group A Streptococcal pharyngitis:
- Tenderness/enlargement of anterior cervical lymph nodes
- Absence of cough, rhinorrhea or laryngitis
- Strep throat exposure in previous 2 weeks
- Throat swab recommended & treat according to C&S results
- Macrolide and clindamycin resistance has been increasing.
- No in vitro resistance to penicillin.
Recommended therapy (10 day duration)
- Therapy can be delayed while awaiting throat culture results and still prevent rheumatic fever.
Penicllin VK 600 mg PO BID
Penicillin allergic (rash)
Cephalexin 500 mg PO QID
Severe pen-allergy or cephalosporin allergy (e.g. anaphylaxis, angioedemia)
Clarithromycin 500 mg PO BID
Complex or Chronic
Refer to BUGS & DRUGS OR Consult with Medical Microbiology / Infectious Disease.
- Non responders (72 h)
- Early relapse (2-7 days post therapy)
- Late relapse or recurrent (confirm by culture)