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:

  • Fever
  • 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)