What Antibiotic Is Best For Strep Throat?

Strep throat is an infection in the throat or tonsils caused by Streptococcus pyogenes — group A beta-hemolytic streptococcus.

The condition is common among school-going children but can also affect adults. Strep throat can cause other symptoms, including fever, swollen tonsils, and swollen lymph nodes.

Speak to your doctor if you develop symptoms. They will carry out a rapid strep test to confirm your diagnosis and recommend treatment. Treatment usually involves antibiotics.

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What is strep throat?

Unlike regular sore throat caused by allergies or a virus, strep throat is caused by Streptococcus pyogenes (group A strep), a type of bacteria.

The infection spreads through direct contact with droplet secretions from an infected person or by inhaling those droplets.

Strep throat must be properly diagnosed and treated to prevent possible complications.

Strep throat symptoms and diagnosis

Strep throat can cause the following symptoms:

  • Pain when swallowing

  • Fever

  • Headache

  • Abdominal pain

  • Nausea

  • Swollen and/or painful lymph glands in the neck

  • Swollen and red tonsils and throat

  • Pus on the tonsils (you might see white patches or streaks)

  • Loss of appetite

  • Fatigue, or feeling generally unwell

You might not have strep throat if you have a cough, a hoarse voice, conjunctivitis, oral ulcers, or a runny nose. These symptoms typically indicate a virus is causing your sore throat.

Your doctor will carry out a rapid antigen detection test (RADT) to determine if you have strep throat. Alternatively, they will use a throat culture, considered the gold standard for diagnosing this infection. A backup throat culture is used to test children with suspected strep throat who have a negative RADT test.¹ ²

Strep throat complications

It’s uncommon to develop serious complications from strep throat, but it is possible without treatment.

Complications of strep throat include the following:³ ⁴

  • Acute rheumatic fever

  • Post-streptococcal glomerulonephritis (PSGN)

  • Scarlet fever

  • Abscesses (pockets of pus) around the neck or tonsils

  • Otitis media (middle ear infection)

  • Mastoiditis (an infection of the mastoid bone behind the ear)

  • Sinus infections

  • Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)

In rare cases, an invasive strep infection can occur when the bacteria enter the blood and lymphatic system. This is more likely in people with chronic illnesses like diabetes and cancer. Examples of invasive strep infections include necrotizing fasciitis and streptococcal toxic shock syndrome.⁵

Antibiotics can help prevent serious complications.

Using antibiotics for strep throat

Most sore throats are caused by a viral infection. In this case, treatment only relieves symptoms while your immune system fights the infection.⁶

In contrast, strep throat is a bacterial infection. It could go away on its own, but untreated strep throat can cause more serious illnesses. Antibiotics are recommended for this reason.

These powerful medications work by killing the bacteria or inhibiting their growth — typically by preventing bacterial walls from forming. Antibiotics have also been shown to:

  • Reduce the duration and severity of symptoms

  • Prevent serious complications that may occur due to untreated strep throat, like rheumatic fever

  • Limit the spread of infection to others

Your doctor might give you a shot or prescribe an antibiotic in tablet, capsule, or liquid form. You should start feeling better within a day or two of taking antibiotics.

Be sure to take the medicine as your doctor prescribes and finish the full course to avoid recurrence.

Antibiotics, like other medications, can cause adverse effects that range from mild to severe. Some medications are unsuitable for certain groups, including those who are pregnant or have other health conditions.

You must speak to your doctor before taking antibiotics for strep throat. They will determine your individual dose and whether the medication is safe for you.

Penicillin and amoxicillin for strep throat

Several antibiotics can be used to treat strep throat. The most common are phenoxymethylpenicillin (penicillin V), benzylpenicillin (penicillin G), and amoxicillin. These drugs are all penicillin antibiotics. They are considered first-line antibiotics for strep throat due to their efficacy, safety, low cost, and narrow spectrum.

They all work similarly: by killing the bacteria by inhibiting bacterial cell wall synthesis. Gram-positive bacteria such as group A strep have cell walls made from thick layers of peptidoglycan that are susceptible to outside factors. These antibiotics will interfere with the formation of the bacterial cell wall.

Without their cell walls, bacteria are vulnerable to outside pressures that can cause them to die. This is why penicillins are considered bactericidal cell wall inhibitors.

According to the Centers for Disease Control and Prevention (CDC), there is no evidence of group A streptococci developing resistance to penicillin. Despite extensive use, this antibiotic remains the most effective for fighting strep throat. Meanwhile, resistance to other types of antibiotics is common.⁷ ⁸

Additionally, penicillin is the only antibiotic studied and demonstrated to reduce rates of acute rheumatic fever.⁹

If you have a penicillin allergy, you may use other antibiotics, such as cephalosporins, clindamycin, or macrolides, depending on local resistance patterns and your specific needs.

Can you take penicillin and amoxicillin together for strep throat?

Typically no. Both medications are penicillin-type antibiotics. They work in the same way to stop the growth and spread of bacteria, so there’s no added advantage to taking them together. They are both first-choice treatments for strep throat.

Cephalosporin antibiotics for strep throat

Cephalosporins are medications commonly used to treat strep. They are classified as bactericidal, similar to penicillins.¹⁰

Cephalosporins are categorized into five generations, indicating the type of coverage they provide against gram-positive and gram-negative bacteria.

  • First generation (e.g., cephalexin and cefadroxil)

  • Second generation (e.g., cefuroxime)

  • Third generation (e.g., cefpodoxime, cefixime, and cefdinir)

Fifth- and fourth-generation cephalosporins are not typically used to treat strep throat.

Azithromycin for strep throat

Azithromycin is a broad-spectrum antibiotic that belongs to the macrolide drug class. Common brand names include Zithromax and Zmax.

This drug is not the first or most common choice for strep throat infection, but it can come in handy in people with severe penicillin allergy.

Clindamycin for strep

Clindamycin also belongs to the macrolide family of antibiotics. Chemically, it’s also considered a lincosamide. It works in a similar way to erythromycin, another macrolide antibiotic.

Clindamycin may be useful if you’re unable to take penicillins and cephalosporins to treat your strep throat infection.

Will strep throat go away without antibiotics?

Strep throat can clear on its own, but taking the full course of antibiotics as prescribed by your doctor is the best way to treat the infection.

You can also try at-home treatments for strep throat that can help you manage the unpleasant symptoms while you recover. Below are some examples:

  • Take over-the-counter pain medications like ibuprofen to help relieve throat pain and reduce fever.

  • Get plenty of rest.

  • Lubricate your throat by drinking plenty of water.

  • Eat soft, easy-to-swallow foods like mashed potatoes and soup.

  • Drink hot beverages to help soothe your throat. You can add lemon and honey, although children younger than one year should not consume honey. Some people prefer the soothing effect of cold beverages, so see what works for you.

  • Avoid spicy or acidic food that could irritate your throat further.

  • Gargle with warm salt water.

  • Stay away from irritants like cigarettes and fumes from paint or cleaning products.

  • Suck on throat lozenges — these have pain-relieving (analgesic) ingredients.

  • Maintain good personal hygiene to avoid spreading the bacteria by washing your hands, covering your mouth when coughing, wearing a tight-fitting mask in enclosed and busy spaces, and not sharing personal items.¹¹

  • Use a humidifier: breathing in moist air can help reduce the discomfort in your throat. Ensure you follow the manufacturer’s instructions for using and cleaning your humidifier to prevent the growth of bacteria and mold, which can worsen your allergies and other symptoms.

The lowdown

If you think you have strep throat, seeing your doctor is a good idea. They will perform tests to confirm your diagnosis. If you test positive for strep A infection, your doctor will likely prescribe an appropriate antibiotic for you. In most cases, it will be penicillin or amoxicillin.

Despite these antibiotics being the most effective for strep throat, some people are allergic to penicillin. In this case, your doctor would likely prescribe azithromycin or clindamycin.

Remember that these drugs could cause mild to serious side effects, and they are unsuitable for some people. Your doctor will decide which drug is best for you and your circumstances.

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