How Strep Throat Is Treated

strep throat prevention
Strep throat prevention. Illustration by Joshua Seong. © Verywell, 2017.

Strep throat is treated with prescription antibiotics, such as penicillin, amoxicillin, and erythromycin, among others. Many with the infection also turn to over-the-counter options, like ibuprofen, or home remedies to reduce pain and ease other uncomfortable symptoms. Getting a doctor to confirm that what you're experiencing is indeed strep is important, as that diagnosis will help ensure you get the treatment needed to address the infection and thwart complications that can arise when it persists.

Prescriptions

Prescription antibiotics are the treatment of choice for strep throat for several reasons:

If you do not have an allergy to penicillin, you will likely be prescribed:

  • Penicillin V
  • Amoxicillin

However, if you do have a penicillin allergy, there are safe alternatives to the above:

  • Cephalexin
  • Cefadroxil
  • Clindamycin
  • Azithromycin
  • Erythromycin
  • Clarithromycin

Note: Any antibiotic that ends in -cillin is part of the penicillin family and will not be used.

Effectiveness

How well an antibiotic works for you depends on a few factors, including:

  • Whether or Not You Really Have Strep: Antibiotics are not effective against viral infections, like the common cold or the flu. Before your doctor prescribes an antibiotic, you need to have verification that you truly have strep throat (either via a  rapid strep test or a throat culture). 
  • Timing: There is clinical evidence that individuals who receive their prescription too early (within the first 48 hours) in the course of their illness are at a higher risk for recurring strep throat. However, it is not recommended that doctors delay treatment of strep throat unless they are treating an individual with recurring strep throat.
    • Taking Antibiotics As Directed: Not completing the full course of antibiotics can predispose you to persistent strep throat and risks of acquiring other illnesses like rheumatic fever or kidney disease. The bacteria may also become resistant to the antibiotic that you didn't complete, adding to your chances of developing antibiotic-resistant strep infection.

    Cautions

    There are many different kinds of bacteria that live in the back of the throat that don't make you sick. In fact, these bacteria, called "normal flora," actually fight off foreign bacteria that is harmful to your body.

    However, most antibiotics don't discriminate, destroying the normal flora along with the bacteria responsible for strep throat. This makes it very easy to contract another case of strep throat within the first month or so after your initial treatment, even if the first antibiotic was successful.

    Antibiotic resistance has been reported with the use of these drugs to treat strep throat, though resistant strains of the associated bacteria are not common. Resistance has been reported with all antibiotics, but Zithromax (azithromycin), which you may recognize as Z-pak, has been most associated with this. 

    If the first course of antibiotics does not work for you, a new antibiotic typically will.

    Still, the possibility of contributing to the evolution and prevalence of superbugs—bacteria resistant to many types of antibiotics—is why doctors take care when making the decision to recommend them, and why they stress the need for you to follow their instructions when they do.

    Over-the-Counter Therapies

    If you have strep throat, some over-the-counter therapies can help some of your symptoms as you recover, but they cannot treat the infection or prevent complications. 

    • Tylenol (acetaminophen) or Advil (ibuprofen): These medications can reduce your fever and help with pain; ibuprofen specifically can also help reduce inflammation.
    • Throat Sprays: Products like Chloraseptic contain topical anesthetics (benzocaine, phenol) that can help ease throat pain.
    • Throat Lozenges: There are dozens of options, but you may especially benefit from choosing one that contains an anesthetic. The effect of such lozenges may last longer than that of throat sprays.

    Home Remedies

    Likewise, home remedies can make you more comfortable if you have strep throat, but they cannot cure the infection. These are short-term solutions and do not provide lasting relief. Some home remedies you may find helpful include:

    • Ice packs if you feel hot or if you have a fever
    • Warm blankets, warm drinks, and warm food if you feel cold or if you are experiencing chills
    • Eating soft foods that do not irritate your sore throat
    • Drinking fluids so that you will not become dehydrated
    • Cold food and drinks, such as popsicles or ice cream may ease the pain and discomfort of a sore throat
    • Salt water gargle may help improve comfort
    • Using a cool mist vaporizer or humidifier for comfort

    Surgeries

    If you have had strep throat seven or more times in one year, your doctor will usually consider performing a tonsillectomy. This procedure is more common for children than adults, primarily because children have a higher tendency to experience recurrent strep throat infection. 

    The risks of surgery must be carefully considered. In most cases, a tonsillectomy will solve the problem of recurring strep throat, but not always. It's best to speak with your/your child's doctor about the possible reasons for recurring strep throat and the benefits and risks of surgery before having this procedure.

    Most people can go home on the same day or within 24 hours after surgery. Recovery generally takes five to 10 days. During recovery, cold foods and drinks are recommended for comfort and to decrease swelling. 

    Seek medical attention if fevers go above 100.4  degrees or there's extreme pain, bloody cough, or shortness of breath after surgery.

    Complementary Medicine (CAM)

    There are no effective complementary treatments that can cure strep throat. A study found that garlic can inhibit some activity of the strep bacteria in a laboratory setting, but this has not been replicated in human infection. Similarly, another study found that echinacea extractIon may have an activity that is harmful to the strep bacteria in a lab setting, but the same can't be assumed in humans.

    Honey may ease sore throat symptoms, either due to strep or even the common cold, and it is considered safe for children over age 1 and adults. You can use honey to sweeten warm beverages or just eat a spoonful.

    Throat lozenges, which often contain herbal ingredients such as slippery elm, are also found to be effective for alleviating the discomfort of a sore throat, particularly after surgery.

    In general, relaxation, mindfulness, and stress reduction can optimize your immune system function to reduce your chances of becoming sick in the first place, but these techniques cannot completely prevent you from acquiring infections such as strep throat. 

    Sources:

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    El Hennawi DED, Geneid A, Zaher S, Ahmed MR. Management of recurrent tonsillitis in children. Am J Otolaryngol. 2017 Jul - Aug;38(4):371-374. doi: 10.1016/j.amjoto.2017.03.001. Epub 2017 Mar 3.

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    Sharma SM, Anderson M, Schoop SR, Hudson JB. Bactericidal and anti-inflammatory properties of a standardized Echinacea extract (Echinaforce): dual actions against respiratory bacteria. Phytomedicine. 2010 Jul;17(8-9):563-8. doi: 10.1016/j.phymed.2009.10.022. Epub 2009 Dec 29.

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    van Driel ML, De Sutter AI, Habraken H, Thorning S, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2016 Sep 11;9:CD004406. [Epub ahead of print]