Updated Guidelines Issued for 'Strep' Diagnosis, Treatment

Penicillin or amoxicillin recommended as first-line therapy for Group A streptococcal pharyngitis

TUESDAY, Sept. 11 (HealthDay News) -- The Infectious Diseases Society of America recommends use of penicillin or amoxicillin as first-line treatment for culture-confirmed cases of Group A streptococcal (GAS) pharyngitis, according to updated clinical practice guidelines published online Sept. 9 in Clinical Infectious Diseases.

Stanford T. Shulman, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues updated the guidelines for adult and pediatric patients with GAS pharyngitis and reviewed diagnosis, management, and treatment recommendations.

The researchers note that, although acute pharyngitis is one of the most frequent illnesses for which primary care physicians and pediatricians are consulted, only a relatively small percentage of patients actually have GAS pharyngitis. To prevent inappropriate administration of antimicrobials, physicians should establish the diagnosis of GAS pharyngitis with a throat swab and rapid antigen detection test and/or culture. For confirmed infection with GAS pharyngitis, penicillin or amoxicillin is recommended as the first line of treatment. In penicillin-allergic individuals, treatment options include a first generation cephalosporin; clindamycin or clarithromycin; or azithromycin. Adjunctive therapy, including analgesic or antipyretic agents, can be beneficial in the management of GAS pharyngitis. Aspirin should be avoided in children and adjunctive therapy with corticosteroids is not recommended for children or adults. Tonsillectomy is not recommended solely to decrease the frequency of GAS pharyngitis.

"The guidelines promote accurate diagnosis and treatment, particularly in avoiding the inappropriate use of antibiotics, which contributes to drug-resistant bacteria," Shulman said in a statement. "We recommend penicillin or amoxicillin for treating strep because they are very effective and safe in those without penicillin allergy and there is increasing resistance of strep to the broader-spectrum -- and more expensive -- macrolides, including azithromycin."

Two authors disclosed financial ties to the pharmaceutical industry.

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