Bacterial Pharyngitis Medication
- Author: Maria A Carrillo-Marquez, MD; Chief Editor: Michael Stuart Bronze, MD more...
The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.
Oral penicillin is currently the drug of choice for GABHS pharyngitis. Amoxicillin remains a reliable alternative and offers advantages in terms of easier dosing and increased palatability.
Tetracyclines and trimethoprim/sulfamethoxazole should not be used to treat GABHS pharyngitis owing to higher rates of resistance.
Interferes with synthesis of cell wall by binding to penicillin-binding proteins. Penicillin is the drug of choice to treat GABHS pharyngitis, as recommended by expert committees of the American Heart Association, American Academy of Pediatrics, and the Infectious Disease Society of America, because of proven efficacy, safety, narrow spectrum, and low cost. Preferred for patients unlikely to complete a full 10-d PO course. S pyogenes remains universally sensitive to penicillin.
Treatment of choice for GAS pharyngitis, as recommended by expert committees of the American Heart Association, American Academy of Pediatrics, and the Infectious Disease Society of America, because of its proven efficacy, safety, narrow spectrum, and low cost. Inhibits biosynthesis of cell wall by binding to penicillin-binding proteins. Bactericidal against sensitive organisms when adequate concentrations are reached and most effective during stage of active multiplication. Inadequate concentrations may be ineffective. GABHS remains uniformly susceptible in vitro.
Interferes with synthesis of cell wall mucopeptides by binding to penicillin-binding proteins. Often used in place of oral penicillin VK in young children. Efficacy equal to penicillin, and often chosen because of the unpalatability of the penicillin susp.
Inhibits RNA-dependent protein synthesis at the 50s ribosome. Can be given as a single daily dose, is better tolerated than erythromycin in patients who are allergic to penicillin, and is effective in a 5-d course. However, much more expensive and should be avoided as first-line therapy in patients with streptococcal pharyngitis. Sporadic resistance has been reported.
Belongs to the lincosamide class of antibiotics. Binds to the 50s ribosome and prevents bacterial protein synthesis. Is an option for symptomatic patients with multiple, recurrent episodes of pharyngitis proven by culture or rapid antigen testing.
Inhibits RNA-dependent protein synthesis at the 50s ribosome. An option in those with severe allergic reactions to beta-lactam antibiotics. Sporadic resistance has been reported.
First-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Oral cephalosporins are highly effective for streptococcal pharyngitis, and several studies have found them to have slightly higher eradication rates than those of penicillin. Second-line agents in the treatment of patients with GABHS pharyngitis.
Semisynthetic macrolide antibiotic that reversibly binds to P site of 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl t-RNA from ribosomes, causing bacterial growth inhibition.
Similar susceptibility profile to erythromycin but has fewer adverse effects.
First generation semi-synthetic cephalosporin, that arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms.
[Guideline] Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15. 55(10):1279-82. [Medline].
Spellerberg B, Brandt C. Streptococcus. Manual of Clinical Microbiology. 9th edition. 2007. 412-29.
Guilherme L, Kalil J, Cunningham M. Molecular mimicry in the autoimmune pathogenesis of rheumatic heart disease. Autoimmunity. 2006 Feb. 39(1):31-9. [Medline].
Dale JB. Current status of group A streptococcal vaccine development. Adv Exp Med Biol. 2008. 609:53-63. [Medline].
Stollerman GH, Dale JB. The importance of the group a streptococcus capsule in the pathogenesis of human infections: a historical perspective. Clin Infect Dis. 2008 Apr 1. 46(7):1038-45. [Medline].
Sriskandan S, Faulkner L, Hopkins P. Streptococcus pyogenes: Insight into the function of the streptococcal superantigens. Int J Biochem Cell Biol. 2007. 39(1):12-9. [Medline].
Musher DM. How contagious are common respiratory tract infections?. N Engl J Med. 2003 Mar 27. 348(13):1256-66. [Medline].
Brook I, Gober AE. Persistence of group A beta-hemolytic streptococci in toothbrushes and removable orthodontic appliances following treatment of pharyngotonsillitis. Arch Otolaryngol Head Neck Surg. 1998 Sep. 124(9):993-5. [Medline].
Roos K, Lind L, Holm SE. Beta-haemolytic streptococci group A in a cat, as a possible source of repeated tonsillitis in a family. Lancet. 1988 Nov 5. 2(8619):1072. [Medline].
Wilson KS, Maroney SA, Gander RM. The family pet as an unlikely source of group A beta-hemolytic streptococcal infection in humans. Pediatr Infect Dis J. 1995 May. 14(5):372-5. [Medline].
Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. Natl Health Stat Report. 2008 Aug 6. 1-29. [Medline].
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005 Nov. 5(11):685-94. [Medline].
Pfoh E, Wessels MR, Goldmann D, Lee GM. Burden and economic cost of group A streptococcal pharyngitis. Pediatrics. 2008 Feb. 121(2):229-34. [Medline].
Alter SJ, Vidwan NK, Sobande PO, Omoloja A, Bennett JS. Common childhood bacterial infections. Curr Probl Pediatr Adolesc Health Care. 2011 Nov. 41(10):256-83. [Medline].
Centor RM, Allison JJ, Cohen SJ. Pharyngitis management: defining the controversy. J Gen Intern Med. 2007 Jan. 22(1):127-30. [Medline].
Gerber MA, Randolph MF, Martin NJ, Rizkallah MF, Cleary PP, Kaplan EL. Community-wide outbreak of group G streptococcal pharyngitis. Pediatrics. 1991 May. 87(5):598-603. [Medline].
Cohen D, Ferne M, Rouach T, Bergner-Rabinowitz S. Food-borne outbreak of group G streptococcal sore throat in an Israeli military base. Epidemiol Infect. 1987 Oct. 99(2):249-55. [Medline]. [Full Text].
Stryker WS, Fraser DW, Facklam RR. Foodborne outbreak of group G streptococcal pharyngitis. Am J Epidemiol. 1982 Sep. 116(3):533-40. [Medline].
Turner JC, Hayden FG, Lobo MC, Ramirez CE, Murren D. Epidemiologic evidence for Lancefield group C beta-hemolytic streptococci as a cause of exudative pharyngitis in college students. J Clin Microbiol. 1997 Jan. 35(1):1-4. [Medline].
Zaoutis T, Attia M, Gross R, Klein J. The role of group C and group G streptococci in acute pharyngitis in children. Clin Microbiol Infect. 2004 Jan. 10(1):37-40. [Medline].
Llor C, Madurell J, Balagué-Corbella M, Gómez M, Cots JM. Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial. Br J Gen Pract. 2011 May. 61(586):e244-51. [Medline]. [Full Text].
Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24. 119(11):1541-51. [Medline].
Shah M, Centor RM, Jennings M. Severe acute pharyngitis caused by group C streptococcus. J Gen Intern Med. 2007 Feb. 22(2):272-4. [Medline].
American Academy of Pediatrics. Arcanobacterium haemolyticum Infections. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 238-9.
Miller RA, Brancato F, Holmes KK. Corynebacterium hemolyticum as a cause of pharyngitis and scarlatiniform rash in young adults. Ann Intern Med. 1986 Dec. 105(6):867-72. [Medline].
Morris SR, Klausner JD, Buchbinder SP, et al. Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study. Clin Infect Dis. 2006 Nov 15. 43(10):1284-9. [Medline].
Holder NA. Gonococcal infections. Pediatr Rev. 2008 Jul. 29(7):228-34. [Medline].
Papp JR, Ahrens K, Phillips C, Kent CK, Philip S, Klausner JD. The use and performance of oral-throat rinses to detect pharyngeal Neisseria gonorrhoeae and Chlamydia trachomatis infections. Diagn Microbiol Infect Dis. 2007 Nov. 59(3):259-64. [Medline].
Centers for Disease Control and Prevention. Press Release. First-line Oral Gonorrhea Treatment Available Again in United States. April 25, 2008.
Esposito S, Blasi F, Bosis S, et al. Aetiology of acute pharyngitis: the role of atypical bacteria. J Med Microbiol. 2004 Jul. 53:645-51. [Medline].
Sendi P, Graber P, Lepere F, Schiller P, Zimmerli W. Mycoplasma pneumoniae infection complicated by severe mucocutaneous lesions. Lancet Infect Dis. 2008 Apr. 8(4):268. [Medline].
Arbaji A, Kharabsheh S, Al-Azab S, et al. A 12-case outbreak of pharyngeal plague following the consumption of camel meat, in north-eastern Jordan. Ann Trop Med Parasitol. 2005 Dec. 99(8):789-93. [Medline].
American Academy of Pediatrics. Tularemia. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 768-9.
American Academy of Pediatrics. Diphtheria. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 307-11.
Amess JA, O'Neill W, Giollariabhaigh CN, Dytrych JK. A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital. Br J Biomed Sci. 2007. 64(2):63-5. [Medline].
American Academy of Pediatrics. Fusobacterium Infections. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 331-2.
Batty A, Wren MW. Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs. Br J Biomed Sci. 2005. 62(2):66-70. [Medline].
Jensen A, Hagelskjaer Kristensen L, Prag J. Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by real-time PCR. Clin Microbiol Infect. 2007 Jul. 13(7):695-701. [Medline].
Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am. 2005 Jun. 52(3):729-47, vi. [Medline].
Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics. 2009 Feb. 123(2):437-44. [Medline].
Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev. 2004 Jul. 17(3):571-80, table of contents. [Medline].
Salkind AR, Wright JM. Economic Burden of Adult Pharyngitis: The Payer's Perspective. Value Health. 2007 Dec 17. [Medline].
Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic MV, Al Othman MA. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev. 2009 Jan 21. CD004872. [Medline].
Lennon DR, Farrell E, Martin DR, Stewart JM. Once-daily amoxicillin versus twice-daily penicillin V in group A beta-haemolytic streptococcal pharyngitis. Arch Dis Child. 2008 Jun. 93(6):474-8. [Medline].
Clegg HW, Ryan AG, Dallas SD, et al. Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial. Pediatr Infect Dis J. 2006 Sep. 25(9):761-7. [Medline].
van Driel ML, De Sutter AI, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2010 Oct 6. CD004406. [Medline].
Pichichero ME, Casey JR. Bacterial eradication rates with shortened courses of 2nd- and 3rd-generation cephalosporins versus 10 days of penicillin for treatment of group A streptococcal tonsillopharyngitis in adults. Diagn Microbiol Infect Dis. 2007 Oct. 59(2):127-30. [Medline].
Lakoš AK, Gašparic M, Kovacic D, Pangercic A, Kukuruzovic MM, Baršic B. Safety and effectiveness of azithromycin in the treatment of respiratory infections in children. Curr Med Res Opin. 2011 Dec 1. [Medline].
Chan DS, Demers DM, Bass JW. Antimicrobial liquid formulations: a blind taste comparison of three brands of penicillin VK and three brands of amoxicillin. Ann Pharmacother. 1996 Feb. 30(2):130-2. [Medline].
Gruchalla RS, Pirmohamed M. Clinical practice. Antibiotic allergy. N Engl J Med. 2006 Feb 9. 354(6):601-9. [Medline].
Richter SS, Heilmann KP, Beekmann SE, et al. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis. 2005 Sep 1. 41(5):599-608. [Medline].
Malhotra-Kumar S, Lammens C, Chapelle S, et al. Macrolide- and telithromycin-resistant Streptococcus pyogenes, Belgium, 1999-2003. Emerg Infect Dis. 2005 Jun. 11(6):939-42. [Medline].
Tanz RR, Shulman ST, Shortridge VD, et al. Community-based surveillance in the united states of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis. 2004 Dec 15. 39(12):1794-801. [Medline].
Kaplan EL. The group A streptococcal upper respiratory tract carrier state: an enigma. J Pediatr. 1980 Sep. 97(3):337-45. [Medline].
Orvidas LJ, St Sauver JL, Weaver AL. Efficacy of tonsillectomy in treatment of recurrent group A beta-hemolytic streptococcal pharyngitis. Laryngoscope. 2006 Nov. 116(11):1946-50. [Medline].
[Guideline] Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011 Jan. 144(1 Suppl):S1-30. [Medline].
Catanzaro FJ, Stetson CA, Morris AJ, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med. 1954 Dec. 17(6):749-56. [Medline].
American Academy of Pediatrics. Group A Streptococcal Infections. Red Book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. 668-80.
Steer AC, Danchin MH, Carapetis JR. Group A streptococcal infections in children. J Paediatr Child Health. 2007 Apr. 43(4):203-13. [Medline].
Dagnelie CF, van der Graaf Y, De Melker RA. Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice. Br J Gen Pract. 1996 Oct. 46(411):589-93. [Medline].
Kassutto S, Rosenberg ES. Primary HIV type 1 infection. Clin Infect Dis. 2004 May 15. 38(10):1447-53. [Medline].