Reviewed by Shipra Gupta, MD, MS, Children’s Hospital at Montefiore
Bottomline- Shorter (5–7 day) or no antibiotic treatment for streptococcal pharyngitis was as effective as the standard 10-day course in a retrospective single-center before-after study. There was no increase in repeat infections, complications, or household transmission, making shorter courses a safe option for low-risk patients.
A new real-world study from New Zealand challenges the long-held belief that 10-day antibiotic courses are necessary to prevent serious complications like acute rheumatic fever (ARF). For decades, fear of ARF—a rare but serious consequence of untreated strep throat—has driven extended antibiotic use, even in low-risk patients. This large observational study found that shorter antibiotic courses (5–7 days), or even no antibiotics at all, were just as effective as the standard 10-day regimen in various outcomes. There was no increase in repeat infections, hospitalizations, household spread, or immune-related complications. Importantly, high-risk patients (e.g., Māori or Pacific individuals aged 3–35 years) were excluded from shortened treatment, and the 10-day standard was maintained for these groups. For the broader low-risk group, the findings support shorter treatment as both safe and effective. However, the study was not powered to detect very rare outcomes like ARF or suppurative complications from streptococcal infections. While no ARF cases occurred in the low-risk group, caution and further research are warranted to confirm safety at the population level.
Reference:
Bloomfield, M., Reed, H., Todd, S., et al. (2025). Effect of a Widespread Reduction in Treatment Duration for Group A Streptococcal Pharyngitis on Outcomes Including Household Transmission. Open forum infectious diseases, 12(7), ofaf323. https://doi.org/10.1093/ofid/ofaf323