Recurrent Strep Throat: How Best to Treat

For patients who have repeated culture-positive episodes of streptococcalpharyngitis, current recommendations include treatment with amoxicillin/clavulanate or clindamycin. If the infectious agent is penicillin-sensitiveand especially if the patient responds well to penicillin VK with each episode,would a longer course of penicillin be a more effective treatment?-- MDAll group A streptococci are highly sensitive to penicillin. Therefore,when treatment failure occurs, it is not because of antibioticresistance. Recurrent episodes of "strep throat" are often recurrencesof viral pharyngitis in a patient who is a chronic pharyngealcarrier of streptococci. Penicillins are relatively poor ateradicating carriage, but clindamycin is effective more than 90% of the time.Some authors believe that persistent or recurrent streptococcal infectionsrepresent a situation in which the presence of a co-pathogen capable ofdestroying penicillin or amoxicillin, such as Staphylococcus aureus, enablesthe streptococci to survive. They justify use of a broader-spectrum antibioticon that basis. However, there is no convincing evidence to support this theoryor the use of broader-spectrum agents.-- Stanford T. Shulman, MD
   Professor of Pediatrics
   Feinberg School of Medicine
   Northwestern University
   Chief, Division of Infectious Diseases
   Children's Memorial Hospital
   Chicago