What antibiotics are used for strep throat in nursing?

October 11, 2025 •

4 min read

According to the CDC, penicillin or amoxicillin is the antibiotic of choice for confirmed group A streptococcal (GAS) pharyngitis, commonly known as strep throat. For nursing, understanding what antibiotics are used for strep throat, as well as managing patient care and educating on infection control, is essential for positive patient outcomes.

Quick Summary

This article explains the antibiotics used for strep throat, including first-line options and alternatives for patients with penicillin allergies. It also details key nursing considerations, patient education, infection control, and management to ensure optimal treatment and prevent complications.

Key Points

First-line Treatment: Penicillin and amoxicillin are the first-line antibiotics for strep throat in non-allergic patients.
Penicillin Allergy Alternatives: First-generation cephalosporins (for mild allergy) and macrolides like azithromycin or clindamycin (for severe allergy) are used for patients with penicillin allergies.
Adherence is Crucial: Nurses must educate patients on completing the full antibiotic course, typically 10 days, to prevent complications like rheumatic fever.
Symptom Management: Nursing care includes administering analgesics and encouraging fluids to manage pain, fever, and dehydration.
Infection Control: Education on hand hygiene and not sharing personal items is essential, as patients remain contagious for at least 24 hours after starting antibiotics.
Monitoring for Complications: Nurses must observe for potential issues like worsening symptoms or severe diarrhea, which can be side effects of antibiotic therapy.
Patient Education: Explaining antibiotic use, side effects, and when to seek further care is a critical part of the nursing role.

First-line antibiotic treatment for strep throat

For patients without a penicillin allergy, the primary antibiotics used to treat strep throat are penicillin and amoxicillin. These are effective, inexpensive, and have not shown widespread resistance by Group A Streptococcus (GAS) bacteria over the decades.

Penicillin V: This is a traditional first-line choice for treating strep throat. It is typically administered orally for 10 days to ensure eradication of the bacteria and prevent serious complications, such as rheumatic fever. Pediatric dosing is based on weight. Nurses must educate patients on the importance of completing the full 10-day course, even if symptoms improve earlier.
Amoxicillin: Often preferred for pediatric patients due to its improved taste and easier dosing schedule, which can improve adherence. Amoxicillin is considered equally effective as penicillin for treating strep throat. Treatment also requires a full 10-day course to prevent complications. A key nursing consideration is to ensure the appropriate dosage, which is weight-based for children.

Alternative antibiotics for penicillin allergies

For patients with a known penicillin allergy, selecting an appropriate alternative antibiotic is crucial. The choice depends on the type and severity of the allergic reaction.

For mild, non-anaphylactic penicillin allergies: A first-generation cephalosporin may be used. Cephalexin and cefadroxil are common options. Nurses should carefully screen for prior allergic reactions to penicillin to determine if a cephalosporin is safe, as there is a small risk of cross-reactivity. A 10-day course is standard for cephalosporins.
For severe (anaphylactic) penicillin allergies: Macrolide antibiotics or clindamycin are necessary alternatives to avoid cross-reactivity.
- Azithromycin: A macrolide that offers a shorter, more convenient 5-day course. However, nurses should be aware of regional variations in bacterial resistance to macrolides, which is a known issue, unlike with penicillin.
- Clindamycin: A lincosamide antibiotic used for patients with severe penicillin allergies or those with recurrent strep throat. A 10-day course is typically prescribed. Nurses should monitor for potential side effects, including gastrointestinal upset and antibiotic-associated diarrhea.

Nursing considerations and patient education

Nursing care for patients with strep throat goes beyond medication administration. It involves comprehensive assessment, intervention, and education to ensure successful treatment and prevent spread of the infection.

Ensuring Treatment Adherence: Nurses play a vital role in emphasizing the importance of completing the full antibiotic course. Poor adherence can lead to treatment failure, bacterial relapse, and serious complications like rheumatic fever or kidney inflammation. Practical advice, such as setting phone reminders, can be helpful.
Symptom Management: Antibiotics begin working within 24 to 48 hours, but symptomatic relief is important for patient comfort. Nurses can recommend supportive care measures:
- Pain relief with over-the-counter analgesics like acetaminophen or ibuprofen (avoiding aspirin in children).
- Encouraging hydration with water, broth, or warm tea.
- Suggesting throat lozenges or salt water gargles.
- Use of a cool-mist humidifier to soothe throat irritation.
Infection Control: Patient education on preventing transmission is a core nursing responsibility. Strep throat is contagious until the patient has been on antibiotics for at least 24 hours and is fever-free.
- Teach proper hand hygiene and respiratory etiquette.
- Advise separating personal items like eating utensils, cups, and towels.
- Recommend replacing toothbrushes after 24 hours of antibiotic treatment to prevent reinfection.
Monitoring for Complications: Nurses must be vigilant in monitoring for signs of worsening infection or potential complications. Patients and caregivers should be instructed to contact a healthcare provider if symptoms do not improve within 48 hours or if new, concerning symptoms appear.

Comparing antibiotic options for strep throat


Feature	Penicillin / Amoxicillin	First-Gen Cephalosporins	Macrolides (Azithromycin)	Clindamycin
Patient Type	Non-allergic patients	Non-anaphylactic penicillin allergy	Severe penicillin allergy	Severe penicillin allergy, recurrent infections
Typical Duration	10 days	10 days	5 days	10 days
Dosing Frequency	2-4 times daily (penicillin), 2 times daily (amoxicillin)	2-4 times daily (cephalexin)	1 time daily	3-4 times daily
Relative Cost	Inexpensive	Moderate	Moderate to High	Moderate to High
Adherence Advantage	Amoxicillin's taste and BID dosing aid adherence	Generally good with standard dosing	Shorter course aids adherence	Less convenient frequency may affect adherence
Resistance Concerns	No resistance in GAS	No resistance in GAS	Known resistance exists	Resistance can occur
Common Side Effects	Rash, GI upset	GI upset, rash	GI upset, diarrhea	Diarrhea, abdominal pain

Conclusion

For nurses managing patients with strep throat, understanding the pharmacology of the primary and alternative antibiotic options is critical for safe and effective care. The standard treatment for non-allergic patients remains penicillin or amoxicillin, while alternative choices are carefully selected based on the nature of a penicillin allergy. Beyond medication administration, the nursing role is centered on patient and family education regarding medication adherence, symptomatic relief, and robust infection control practices to prevent the spread of illness and reduce the risk of serious post-streptococcal complications. By providing comprehensive, evidence-based care and education, nurses empower patients and their families to manage strep throat effectively.

What are the nursing interventions for strep throat?

Key nursing interventions for strep throat include administering prescribed antibiotics, promoting hydration, managing pain and fever with analgesics, educating the patient and family on medication adherence, and teaching proper infection control measures to prevent transmission. Nurses also monitor for complications and assess for signs of dehydration.

Frequently Asked Questions

Penicillin or amoxicillin are the primary antibiotics used for strep throat in patients who do not have a penicillin allergy. They are highly effective, inexpensive, and have not developed resistance in Group A Streptococcus (GAS) bacteria.

For patients with a non-anaphylactic penicillin allergy, first-generation cephalosporins like cephalexin can be used. For severe (anaphylactic) allergies, macrolides such as azithromycin or clindamycin are recommended to avoid cross-reactivity.

Antibiotic treatment for strep throat is typically a 10-day course for penicillin, amoxicillin, cephalosporins, and clindamycin. Azithromycin is an exception, with a shorter 5-day course.

It is crucial to complete the entire course of antibiotics, even if symptoms improve, to ensure all bacteria are eliminated. This prevents bacterial relapse and serious complications, such as rheumatic fever, which can damage the heart.

Nurses can help manage strep throat symptoms by providing over-the-counter pain relievers, encouraging fluid intake, suggesting throat lozenges or warm salt water gargles, and recommending rest. A cool-mist humidifier can also soothe the throat.

Strep throat patients are considered contagious until they have been on antibiotics for at least 24 hours and are fever-free. During this period, strict infection control measures should be followed.

Common side effects include gastrointestinal upset, nausea, vomiting, and diarrhea. Patients should be advised to contact their healthcare provider if severe diarrhea or other concerning symptoms occur.