From the Guidelines
The child should be evaluated by a healthcare provider since amoxicillin hasn't resolved the sore throat after 5 days, and the provider may consider switching to a different antibiotic like azithromycin or amoxicillin-clavulanate if bacterial infection is confirmed, as the current treatment regimen may not be effective in eradicating the infection, according to the guidelines by the Infectious Diseases Society of America 1. The child's persistent sore throat could indicate strep throat resistant to amoxicillin, a viral infection, or another condition entirely. The provider may perform a rapid strep test or throat culture to determine the cause of the sore throat. If symptoms worsen with fever above 101°F, difficulty swallowing, or breathing problems, it is essential to seek immediate medical attention. In the meantime, the child can use salt water gargles, drink plenty of fluids, and take acetaminophen or ibuprofen for pain relief. It is crucial to note that the initial treatment with amoxicillin was likely inadequate, as the recommended duration for amoxicillin treatment is 10 days, not 5 days, as stated in the guidelines 1. Therefore, the healthcare provider should reassess the child's condition and consider alternative treatment options, such as azithromycin (12 mg/kg once daily for 5 days) or amoxicillin-clavulanate (45 mg/kg/day divided twice daily for 10 days), to ensure proper treatment and prevent potential complications like rheumatic fever or kidney inflammation. The American Heart Association also recommends that patients with streptococcal pharyngitis receive adequate therapy to prevent rheumatic fever, and the treatment regimen should be selected based on factors such as bacteriologic and clinical efficacy, ease of adherence, and potential side effects 1. In this case, the healthcare provider should prioritize the child's morbidity, mortality, and quality of life by selecting an effective treatment regimen and ensuring proper follow-up care.
From the Research
Patient's Condition
- The patient is a 10-year-old boy with a sore throat.
- He was given amoxicillin 500 mg BID 5 days ago and still shows no improvement.
Diagnosis and Treatment
- According to 2, the diagnosis of streptococcal pharyngitis can be made using throat culture, rapid antigen detection testing, or the modified Centor score.
- The treatment of choice for streptococcal pharyngitis is penicillin or amoxicillin, with a recommended course of 10 days 2, 3.
- If the patient is not responding to amoxicillin, it may be necessary to reevaluate the diagnosis and consider other causes of sore throat, such as viral pharyngitis 3.
Antibiotic Treatment
- 4 suggests that there is no significant difference in symptom resolution between cephalosporins and penicillin in the treatment of GABHS tonsillopharyngitis.
- However, low-certainty evidence suggests that carbacephem may be more effective than penicillin for symptom resolution in adults and children 4.
- Azithromycin may not be more effective than amoxicillin in resolving symptoms, and may have a higher risk of adverse events 4.
Next Steps
- Reevaluate the patient's symptoms and consider other causes of sore throat, such as viral pharyngitis 3.
- Consider switching to a different antibiotic, such as penicillin or carbacephem, if the patient is not responding to amoxicillin 2, 4.
- Monitor the patient's symptoms and adjust treatment as necessary to ensure proper management of the condition 3.