Strep throat is treated with antibiotics, most commonly amoxicillin or penicillin, taken for 10 days. Alongside the antibiotic, over-the-counter pain relievers like ibuprofen or acetaminophen help manage throat pain and fever while the medication works.
The First-Choice Antibiotics
Amoxicillin and penicillin are the preferred antibiotics for strep throat. They’ve been the go-to options for decades because they’re effective, affordable, and the bacteria that cause strep (group A Streptococcus) haven’t developed resistance to them. Both require a full 10-day course, even though you’ll likely feel better within two or three days.
Amoxicillin is often the pick for children because it tastes better in liquid form and can be taken just once or twice a day. Adults are typically prescribed penicillin, taken twice daily at 500 mg or four times daily at 250 mg. Children’s doses are calculated by weight.
There’s also a single-shot option: an injection of long-acting penicillin given in the muscle at a clinic. This is sometimes used when there’s concern that a person won’t complete the full 10-day pill course. One injection and you’re done.
If You’re Allergic to Penicillin
A penicillin allergy doesn’t mean strep goes untreated. Several alternatives work well, and your provider will choose based on the type of allergic reaction you’ve had.
If your allergy was mild (a rash, for example, rather than throat swelling or difficulty breathing), a first-generation cephalosporin like cephalexin or cefadroxil is typically prescribed. These are in a related antibiotic family but are generally safe for people whose penicillin reactions weren’t severe. The course is still 10 days.
If your reaction to penicillin was more serious, providers avoid that entire antibiotic family and turn to different classes:
- Azithromycin: A 5-day course, starting with a higher dose on day one and a lower dose for the remaining four days.
- Clarithromycin: Taken twice daily for 10 days.
- Clindamycin: Taken three times daily for 10 days.
Pain Relief While Antibiotics Kick In
Antibiotics kill the bacteria, but they don’t numb the pain. For the first day or two, your throat will still feel raw. Ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) both reduce throat pain and bring down fever. You can alternate between the two if one alone isn’t enough.
Avoid giving aspirin to children or teenagers. It has been linked to Reye’s syndrome, a rare but serious condition, in young people recovering from infections with flu-like symptoms.
Simple comfort measures also help. Warm liquids like broth or tea soothe irritation, cold items like popsicles can temporarily numb the throat, and gargling with warm salt water (about half a teaspoon of salt in a cup of water) reduces swelling. Staying well hydrated matters too, since swallowing hurts less when the throat isn’t dry.
Why You Need to Finish All 10 Days
Most people feel significantly better within 48 to 72 hours of starting antibiotics, and it’s tempting to stop taking them. But the full course isn’t just about clearing your symptoms. It’s about completely eliminating the bacteria to prevent serious complications.
The biggest concern is acute rheumatic fever, a condition where the body’s immune response to lingering strep bacteria attacks the heart, joints, or nervous system. Adequate antibiotic treatment is the primary way to prevent it. Stopping early also increases the chance of the infection bouncing back, sometimes within days.
How Soon You Can Return to Normal
You’re generally considered no longer contagious after about 12 to 24 hours on antibiotics, which is when most schools and workplaces allow people to return. Your symptoms will likely linger a bit longer than that, with throat soreness and fatigue gradually fading over two to five days. If you’re not feeling any improvement after 48 hours on antibiotics, contact your provider, as the infection may need a different approach.
Getting Tested Before Treatment
Strep throat can’t be diagnosed by symptoms alone because viral sore throats look nearly identical. Before prescribing antibiotics, providers use a rapid strep test (results in minutes) or a throat culture (results in one to two days). This matters because antibiotics won’t help a viral infection and using them unnecessarily contributes to antibiotic resistance. If a rapid test comes back negative but strep is still suspected, especially in children, a throat culture may be sent as a backup since it catches cases the rapid test misses.