Therefore, repeated courses of antibiotic treatment are not indicated in asymptomatic individuals. In symptomatic individuals who continue to have GAS in the pharynx after completion of the course of therapy, a second course, preferably with another antibiotic is recommended. Antibiotics such as amoxicillin-clavulanate, cephalosporins, and clindamycin can be used. Chronic streptococcal carriers are defined as individuals with positive throat cultures for GAS without illness or antibody response to GAS antigens. Because it is impossible to distinguish carriers from infected individuals, all individuals who are symptomatic and are identified as having GAS by throat swab or antigen-detection tests must be treated with a course of antibiotics.
Streptococcal carriers are at little risk for developing acute rheumatic fever.