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Treatment Options

Treatment of Group A Streptococcus

A number of antibiotics have been shown to be effective in treating Group A Strep, including penicillin and its congeners (such as ampicillin, amoxicillin, and the semisynthetic penicillins), as well as numerous cephalosporins and macrolides and clindamycin. Penicillin, however, remains the agent of choice and amoxicillin is often used in place of oral penicillin V to treat young children; the efficacy appears to be equal. Intramuscular administration of benzathine penicillin G is preferred for patients who are unlikely to complete a full 10-day course of oral therapy. Erythromycin is a suitable alternative for patients allergic to penicillin. First-generation cephalosporins are also acceptable for patients who do not exhibit immediate-type hypersensitivity to β-lactam antibiotics.

Neither repeat testing of patients who are asymptomatic after a course of antimicrobial therapy, nor routine testing of asymptomatic household contacts of a patient with Group A Strep, are necessary. A small percentage of patients will have a recurrence of acute pharyngitis after a course of antimicrobial therapy and such patients may be treated with the same treatment they initially received. When multiple episodes occur over the course of months or years, it may be difficult to differentiate Group A Strep pharyngitis from viral pharyngitis. Therapy antimicrobial agents such as clindamycin and amoxicillin-clavulanate, may be beneficial, because they have yield high rates of eradication of streptococci from the pharynx under these particular circumstances.

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