From the Guidelines
For an 11-year-old male who developed a rash from penicillin after being diagnosed with strep throat, the recommended alternative treatment is azithromycin (12 mg/kg once daily, maximum 500 mg) for 5 days or clarithromycin (15 mg/kg/day divided twice daily, maximum 250 mg twice daily) for 10 days, as stated in the 2012 update by the Infectious Diseases Society of America 1. The choice of alternative antibiotic depends on the severity of the allergic reaction to penicillin.
- If the rash was not severe or anaphylactic, cephalosporins like cefdinir or cefpodoxime could also be considered, as there is only partial cross-reactivity with penicillin.
- However, if the child experienced a severe allergic reaction to penicillin, macrolides are safer. It is essential for the patient to complete the full course of antibiotics even if symptoms improve quickly.
- Parents should monitor for any new rash or allergic symptoms with the alternative medication and seek immediate medical attention if they occur. Treating strep throat is crucial to prevent complications like rheumatic fever and post-streptococcal glomerulonephritis, and antibiotics help reduce symptom duration and prevent spread to others, as emphasized in the guidelines by the American Heart Association 1. The child should stay home from school until he has been on antibiotics for at least 24 hours and is fever-free. The most recent and highest quality study, which is the 2012 update by the Infectious Diseases Society of America 1, provides the strongest evidence for the recommended treatment. This study is more recent and of higher quality than the other studies provided, such as the 2009 scientific statement from the American Heart Association 1 and the 2002 practice guidelines for the diagnosis and management of group A streptococcal pharyngitis 1. Therefore, the recommendations from the 2012 update should be prioritized.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx
The treatment for an 11-year-old male who was strep positive 2 days ago but developed a rash from penicillin is azithromycin as an alternative to first-line therapy, since the patient cannot use the first-line therapy (penicillin) due to the rash 2.
From the Research
Treatment Options for Strep Positive Patient with Penicillin Rash
- The patient is an 11-year-old male who was strep positive 2 days ago but developed a rash from penicillin, indicating a need for alternative antibiotic treatment 3.
- Macrolides, such as clarithromycin and azithromycin, are rational alternatives to erythromycin for streptococcal pharyngitis/tonsillitis in penicillin-allergic patients 3.
- A study comparing 10 days of clarithromycin with 5 days of azithromycin found that clarithromycin was more effective in eradicating group A streptococci from the throat 4.
- Another study found that 5 days of clarithromycin or amoxicillin/clavulanate treatment had clinical efficacy comparable to 10 days of penicillin V treatment, but amoxicillin/clavulanate and penicillin V were bacteriologically more effective than clarithromycin 5.
- Azithromycin has been shown to be effective in killing Streptococcus pneumoniae, but its effectiveness may be reduced in areas with high resistance rates 6.
- A systematic review of different antibiotic treatments for group A streptococcal pharyngitis found that cephalosporins, macrolides, and carbacephem may be effective alternatives to penicillin, but the evidence is uncertain and more research is needed 7.
Recommended Treatment
- Based on the available evidence, clarithromycin or azithromycin may be suitable alternatives to penicillin for the treatment of streptococcal pharyngitis/tonsillitis in penicillin-allergic patients 3, 4.
- The choice of antibiotic should be based on the patient's medical history, allergy status, and local resistance patterns 7.
- It is essential to consult with a healthcare professional to determine the best course of treatment for the patient 3, 5, 6, 4, 7.