Strep throat is a common respiratory tract infection that affects mainly school-aged children between five and 15 years old. Strep throat infections account for nearly a quarter of all sore throat cases in primary care clinics. Strep throat is a self-limiting infection, which means it can resolve on its own without treatment, but who wants to wait out a sore throat or risk complications from an untreated strep throat infection? 

Oral antibiotics are commonly prescribed for sore throat cases. Even though not all sore throat cases need them, some doctors almost automatically prescribe antibiotics to treat a sore throat, even without determining whether its cause is bacterial or viral. Unfortunately, if it’s a viral infection, the antibiotics won’t do anything except contribute to the growing problem of over-prescribed antibiotics. In most cases of sore throat, it’s actually a virus causing the illness. 

Even if it is a bacterial infection, studies have shown that antibiotic therapy for a sore throat has a modest beneficial effect. However, if it is an actual strep throat infection, there are real benefits to using antibiotics. Strep throat is caused by a bacterium called Streptococcus pyogenes, which belongs to Group A beta-hemolytic Streptococci bacteria. A bacterium that is thankfully very susceptible to antibiotics. 

Antibiotic therapy for strep throat helps by reducing the severity of the symptoms and shortening the length of the illness. Plus, taking antibiotics for a strep throat infection helps prevent serious complications like Rheumatic heart disease, severe inflammation in the kidneys (glomerulonephritis), and painful abscesses.  

So, which antibiotic is the best to treat strep throat?

Generally speaking, the international guidelines for strep throat treatment insist on penicillin as the first choice. And in case of an allergy or an infection seemingly resistant to penicillin, erythromycin is typically the next best option, but your doctor will make the call based on your health and history. Penicillin and erythromycin are the top choices for several reasons, mostly because they are both cost-effective and have a low antibiotic-resistance profile. Despite this, many physicians will prescribe the most recently marketed antibiotics without clear evidence that these new ones have any benefits over penicillin in treating strep throat. 

A recent study compared different classes of antibiotics used to treat strep throat infections. Researchers compared these antibiotics based on how effective they were at decreasing the duration of the illness, alleviating symptoms like pain and fever, preventing relapse and complications, and any reported side effects. The study compared penicillins (penicillin and amoxicillin), cephalosporins, macrolides (azithromycin and erythromycin), and carbacephem. 

When comparing penicillin with cephalosporins, the study found no difference in symptom resolution, Strep throat relapse, or reported side effects. Additionally, the same was true when comparing macrolides with penicillins. However, when comparing carbacephem against penicillin, the study showed that carbacephem was slightly better at resolving the symptoms of Strep throat. Despite this advantage, carbacephem should be used for more serious infections due to the potential risk of developing resistance to the drug, not to mention its high cost compared to penicillin. 

In summary, the study's authors concluded that the results didn't show enough evidence that other antibiotics were more effective than penicillin in treating strep throat. And that penicillin should still be the first choice option for strep throat. While penicillin may reign supreme on paper, talk to your doctor to find the right treatment for you or your child when you’re dealing with strep throat.