Doctors prescribe antibiotics for strep throat, with amoxicillin and penicillin being the top choices. The standard course lasts 10 days, and most people start feeling better within one to two days of their first dose. Beyond antibiotics, doctors often recommend over-the-counter pain relievers and, in some cases, a short course of a steroid to help with severe throat pain.
Amoxicillin and Penicillin: The Go-To Prescriptions
Amoxicillin and penicillin are the first-line antibiotics for strep throat, recommended by both the CDC and the American Heart Association. The reason is simple: the bacteria that cause strep throat (Group A Streptococcus) have never developed resistance to penicillin or related antibiotics. Not a single resistant strain has ever been reported in clinical settings, which makes these drugs a reliable choice every time.
The typical prescription is amoxicillin taken once or twice daily, or penicillin taken two to four times daily, both for 10 days. For adults and older teens, the standard amoxicillin dose tops out at 1,000 mg per day. Children receive a weight-based dose of 50 mg per kilogram per day, up to that same maximum. Penicillin dosing follows a similar weight-based approach, divided into multiple doses throughout the day.
Amoxicillin tends to be the more popular choice for kids because it tastes better in liquid form and can be taken less frequently. Both drugs work equally well at clearing the infection.
If You’re Allergic to Penicillin
For people with a penicillin allergy, doctors turn to alternative antibiotics. Cephalosporins (like cephalexin) are a common substitute for patients whose allergy is mild, since they work through a similar mechanism but are tolerated by most people with penicillin sensitivities. For patients with a severe penicillin allergy, options include azithromycin or clindamycin. Your doctor will choose based on the type of allergic reaction you’ve had in the past.
How Doctors Decide to Prescribe
Not every sore throat is strep, and doctors use a scoring system to decide whether testing or treatment is needed. The Centor score assigns one point for each of four signs: fever, no cough, swollen and tender lymph nodes in the front of the neck, and white patches or pus on the tonsils. A modified version called the McIsaac score adds a point for patients under 15 and subtracts one for those 45 and older, reflecting the fact that strep is far more common in children.
If you score 0 or 1, strep is unlikely and most doctors won’t test or prescribe. A score of 2 typically means a rapid strep test, with antibiotics only if it comes back positive. At 3 or 4, some guidelines support prescribing antibiotics right away, though many doctors still prefer to confirm with a rapid test first. This scoring approach helps avoid unnecessary antibiotic use for viral sore throats, which antibiotics can’t treat.
Pain Relievers and Steroids for Symptom Relief
Antibiotics kill the bacteria, but they don’t provide immediate pain relief. For throat pain and fever, doctors recommend ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). These are available over the counter and can make a significant difference in comfort, especially during the first day or two before antibiotics take full effect. Soft foods, rest, and plenty of fluids also help.
In cases of severe throat pain, particularly when the tonsils are visibly swollen and coated with pus, some doctors add a single dose of an oral steroid alongside the antibiotic. Research in both children and adults shows this can cut the time to pain relief roughly in half. In one study, children who received the steroid began feeling relief at about 9 hours compared to 18 hours with antibiotics alone, and their sore throat fully resolved in about 30 hours instead of 44. The steroid is not a standalone treatment. It’s used as a one-time addition to antibiotics for patients who are especially miserable.
What to Expect After Starting Antibiotics
Most people notice improvement within one to two days of starting their prescription. Fever usually breaks first, followed by gradual relief of throat pain and swelling. You’re generally no longer contagious after about 12 to 24 hours on antibiotics, which is the typical threshold schools and workplaces use for return.
Even though you’ll feel better well before day 10, finishing the entire course matters. Stopping early doesn’t just risk a relapse of the infection. It leaves the door open for more serious complications. Untreated or improperly treated strep can trigger rheumatic fever, an inflammatory condition that affects the heart, joints, brain, and skin. Rheumatic fever can lead to permanent heart valve damage, and in severe cases, it requires surgery or can be fatal. These complications are rare precisely because antibiotics are so effective when taken as prescribed.
When Strep Keeps Coming Back
Some people, especially children, deal with strep throat multiple times in a single year. When the infection returns shortly after finishing a course of antibiotics, doctors may switch to a different antibiotic to rule out treatment failure. They’ll also consider whether the patient is a strep carrier (someone who carries the bacteria without being actively sick) who is actually catching viral sore throats, or whether reinfection is coming from a close contact like a sibling or classmate.
For truly recurrent strep (multiple confirmed infections in a short period), a tonsillectomy may eventually be discussed, though doctors generally reserve that option for cases where infections are frequent, disruptive, and not responding well to antibiotic treatment.