What are the discharge instructions for a 10-year-old boy diagnosed with streptococcal pharyngitis (strep throat)?

From the Guidelines

For a 10-year-old boy with strep throat, it is crucial to complete the full 10-day course of prescribed antibiotics, such as amoxicillin (50 mg/kg once daily, max = 1000 mg) or penicillin V (250 mg twice daily for children), as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• The chosen antibiotic should be taken for the full 10-day duration, even if symptoms improve within a few days, to prevent recurrence or complications.
• The patient can return to school after 24 hours of antibiotic therapy, as he will no longer be contagious.
• To manage symptoms, encourage rest, adequate fluid intake, and soft foods if swallowing is painful.
• Pain and fever can be managed with acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours).
• Warm salt water gargles (1/4 teaspoon salt in 8 oz warm water) may help soothe the throat.

Monitoring and Follow-Up

• It is essential to watch for worsening symptoms, difficulty breathing, or rash, which could indicate complications or an allergic reaction.
• Completing the full antibiotic course is vital to completely eliminate the Streptococcus bacteria and prevent serious complications like rheumatic fever or kidney inflammation, as highlighted in the clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis 1.

Additional Guidance

• The diagnosis of GAS pharyngitis should be established accurately to prevent inappropriate administration of antimicrobials to patients with nonstreptococcal pharyngitis, as emphasized in the IDSA guideline 1.
• Inappropriate antimicrobial use can lead to the development of antimicrobial resistance among common pathogens and expose patients to unnecessary expenses and hazards 1.

From the FDA Drug Label

It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained

For a 10-year-old boy with strep throat, the recommended treatment duration with amoxicillin is at least 10 days to prevent acute rheumatic fever. Treatment should be continued for a minimum of 48 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication is obtained 2.

From the Research

Diagnosis and Treatment of Strep Throat

• The diagnosis of strep throat can be made using throat culture, rapid antigen detection testing, or clinical scoring systems such as the modified Centor score 3.
• The treatment of choice for strep throat is penicillin, with a 10-day course of oral therapy or one injection of intramuscular benzathine penicillin 3.
• Amoxicillin is equally effective and more palatable than penicillin, while erythromycin and first-generation cephalosporins are options for patients with penicillin allergy 3.
• Macrolide antibiotics such as clarithromycin have also been shown to be effective in treating strep throat, with a 10-day course being more effective than a 5-day course of azithromycin 4, 5.

Management and Follow-up

• The goal of treatment is to provide symptom relief, shorten the duration of illness, prevent complications, and decrease the risk of contagion, while minimizing the unnecessary use of antibiotics 6.
• Clinical guidelines developed by professional associations can help medical professionals choose among available techniques to diagnose and treat strep throat, but there is significant controversy regarding the best methods to diagnose GABHS and under what conditions antibiotics should be prescribed 6.
• Chronic carriers of GABHS are at low risk of transmitting disease or developing invasive GABHS infections, and there is generally no need to treat carriers 3.

Specific Considerations for a 10-year-old Boy

• The diagnosis and treatment of strep throat in a 10-year-old boy would follow the same guidelines as for adults, with consideration given to the patient's age, weight, and medical history 3, 6.
• The choice of antibiotic and duration of treatment would depend on the severity of symptoms, the presence of any allergies or sensitivities, and the patient's response to treatment 3, 4, 5.