The standard medicine for strep throat is an antibiotic, most commonly penicillin or amoxicillin. These are the first-choice treatments recommended by the CDC and the Infectious Diseases Society of America, and they’ve remained the go-to options because the bacteria that cause strep throat have never developed resistance to them. The full course lasts 10 days.
Penicillin and Amoxicillin: The First Choice
Penicillin and amoxicillin work by destroying the cell walls of the strep bacteria, killing them off rather than just slowing their growth. Both are equally effective, and your doctor will typically prescribe one based on what’s easiest for you to take.
Amoxicillin is often preferred for children because it tastes better in liquid form and can be taken just once or twice a day. Adults are commonly prescribed penicillin V, taken twice daily at 500 mg or four times daily at 250 mg. Either way, the course runs for 10 days. Even though you’ll likely feel better within two or three days, finishing the entire prescription is important. Stopping early leaves surviving bacteria in your throat, which raises the risk of the infection returning or causing complications.
If You’re Allergic to Penicillin
A penicillin allergy doesn’t leave you without options, but the alternative depends on the type of allergy you have. If your reaction was mild (a rash, for example, rather than throat swelling or difficulty breathing), a first-generation cephalosporin like cephalexin is a common substitute. Cephalosporins are chemically related to penicillin but are generally safe for people whose allergic reactions weren’t severe.
For people with a more serious penicillin allergy, doctors turn to a different class of antibiotics entirely. Azithromycin and clarithromycin are frequently prescribed because they’re well tolerated. Erythromycin is another option in the same family, though it tends to cause more stomach upset, which is why many doctors reach for azithromycin instead. In some cases, particularly when the bacteria have been hard to fully clear, clindamycin may be prescribed.
Over-the-Counter Pain Relief
Antibiotics kill the bacteria, but they don’t do much for pain in the first day or two. Over-the-counter pain relievers can bridge that gap. 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.
One important caution for parents: aspirin should not be given to children or teenagers with strep throat. In young people recovering from infections with flu-like symptoms, aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition that affects the brain and liver.
Beyond medication, simple comfort measures help. Warm liquids, cold foods like popsicles, and salt water gargles can all ease the rawness in your throat while you wait for the antibiotics to kick in.
Steroids for Severe Pain
When throat pain is especially intense, some doctors add a single dose of a steroid to the antibiotic prescription. Research published in The Journal of Emergency Medicine found that patients who received a one-time steroid injection alongside their antibiotics felt pain relief in about 8 hours, compared to roughly 20 hours for those on antibiotics alone. They were also completely pain-free in about 29 hours versus 54 hours. This isn’t routine for every strep case, but it’s sometimes used when swelling and pain are severe enough to make swallowing very difficult.
When You Stop Being Contagious
Once you’ve been on antibiotics for 24 hours and your fever has broken, you’re generally no longer contagious. That’s the standard threshold for returning to work, school, or daycare. Before that 24-hour mark, strep spreads easily through respiratory droplets, so staying home during that window protects the people around you.
Why Treatment Matters
Strep throat will sometimes resolve on its own, but skipping antibiotics is a gamble with real consequences. Without treatment, the bacteria can spread beyond the throat and cause complications including abscesses around the tonsils or in the neck, ear infections, and sinus infections.
The more serious risks are rheumatic fever, which can damage the heart, joints, and brain, and post-streptococcal glomerulonephritis, a kidney disease triggered by the body’s immune response to the lingering infection. These complications are uncommon with proper antibiotic treatment, which is exactly why completing the full 10-day course matters even after symptoms disappear. The antibiotics aren’t just relieving your sore throat. They’re preventing your immune system from overreacting in ways that can harm organs weeks after the infection itself is gone.