Treating Strep throat: how long should I take antibiotics? Which antibiotic is best?

Sore throat is a very common complaint in primary care clinics, especially during cold and flu season. Although the majority of sore throat cases are caused by viruses, approximately more than a quarter are caused by bacteria. According to research from Cochrane Library, strep throat the most common form of bacterial sore throat. It's caused by bacteria belonging to Group A beta-hemolytic Streptococci. Home Strep throat tests are not available but should be in the near future.


Strep throat is common among children, especially school-age kids. Adults are much less likely to get Strep throat but it’s not uncommon. Parents or caregivers for school-age kids are also especially susceptible to Strep throat. 


Although Strep throat is typically self-limiting, meaning that it can resolve spontaneously without medication, antibiotics are generally recommended to treat confirmed cases. Antibiotic therapy is especially encouraged in vulnerable groups like pregnant women, HIV-infected persons, and immune-deficient patients. 


Physicians prescribe antibiotics not only to decrease the length of the infection, but also to alleviate the severity of the symptoms. Additionally, treating Strep throat infections with antibiotics decreases the risk of developing serious complications from a Strep throat infection. One of the most dangerous but preventable complications of Strep throat is Acute Rheumatic Fever (ARF). ARF is characterized by high-grade fever, joint pain, and severe inflammation in the heart that can lead to heart failure. 


Penicillin and similar antibiotics like amoxicillin have been used for decades to treat Strep throat infections, and with few issues. However, in recent years, we’ve seen a rise in antibiotic-resistant bacteria in Strep throat cases. Resistance happens when bacteria learn to fight off the drug that is supposed to kill them. This is why it’s critical to take your full course of antibiotics, even when you start to feel better. By finishing the course, it ensures all the disease-causing bacteria is dead.  


There are also cases when a patient is severely allergic to penicillin, and in those cases, they need a safe alternative. Antibiotic resistance and patient allergies have led to doctors utilizing other types of antibiotics to treat Strep throat like cephalosporins and macrolides. These antibiotics are used for a shorter duration (5 days) compared to amoxicillin (10 days).


Antibiotic resistance has become a global health emergency that demands we use antibiotics intelligently. Both in terms of the antibiotics prescribed and their duration. So which antibiotics are the best for treating Strep throat? Is it best to use a type with a shorter duration like macrolides/cephalosporins or use drugs like amoxicillin with a longer duration? 


Scientists from Denmark conducted a study to answer this question comparing different classes of antibiotics and Strep throat therapy durations. They found that a shorter duration of Amoxicillin is less effective than a longer course in terms of alleviating symptoms and eradicating Strep throat infection. 


The researchers also found that Macrolids were equally effective as amoxicillin, and that cephalosporins were more effective. Despite this, they concluded that a longer duration of amoxicillin (10 days) is still the best for treating Strep throat. 


They argued that cephalosporins and macrolides are high-priority antibiotics used to treat a wide variety of infections, which means they should be saved and used strictly to treat various infections. Unlike Amoxicillin which can be used primarily for treating Strep throat infections. 


To sum up, there are other drugs available when it comes to treating a Strep throat infection, but the standard penicillin/amoxicillin still remain the best choice. These drugs have been tried and tested for centuries and are typically still going to be the best option for treating a Strep throat infection. 


Obviously all cases are different like all bodies are different, and you may need a different type of drug to treat your case. However, you can rest assured that if your doctor prescribes penicillin, you’re taking the tried and true remedy. Just be sure to follow the exact instructions and finish your full ten-day course even as you start to feel better!