From the Guidelines
For a 14-year-old with positive rapid strep test, I recommend amoxicillin 50 mg/kg/day (maximum 1000 mg per dose) divided twice daily for 10 days as first-line treatment. Alternatively, penicillin V 500 mg twice daily for 10 days can be used 1. For penicillin-allergic patients, consider azithromycin 12 mg/kg once daily (maximum 500 mg) for 5 days or clindamycin 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days. The patient should rest, stay hydrated, and can take acetaminophen or ibuprofen for fever and pain relief. They should complete the entire antibiotic course even if symptoms improve quickly. The patient can return to school after 24 hours of antibiotic therapy and when fever-free. Strep throat (Group A Streptococcus) requires antibiotic treatment to prevent complications like rheumatic fever and post-streptococcal glomerulonephritis. Symptoms typically improve within 48 hours of starting antibiotics, but completing the full course is essential to fully eradicate the infection. Some key points to consider in the management of strep throat include:
- Follow-up posttreatment throat cultures or RADT are not recommended routinely, but may be considered in special circumstances (strong, high) 1
- Diagnostic testing or empiric treatment of asymptomatic household contacts of patients with acute streptococcal pharyngitis is not routinely recommended (strong, moderate) 1
- Antistreptococcal antibody titers are not recommended in the routine diagnosis of acute pharyngitis 1
- Testing is generally not recommended in children younger than three years unless the child has risk factors, such as an older sibling with the illness, because the illness is uncommon in this age group 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. Table 1 (12 weeks) n 40 kg Recommended Dosage for Pediatric Patients Aged 3 Months and Older and Weight Less than 40 kg Ear/Nose/Throat Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours
For a 14-year-old patient with a positive rapid strep test, the recommended dosage of amoxicillin is:
- 500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections,
- or 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours. The treatment should be continued for at least 10 days to prevent the occurrence of acute rheumatic fever 2.
From the Research
Diagnosis and Treatment of Streptococcal Pharyngitis
- The diagnosis of streptococcal pharyngitis 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 streptococcal pharyngitis is penicillin, with amoxicillin being an equally effective and more palatable alternative 3.
- For patients with penicillin allergy, erythromycin and first-generation cephalosporins are suitable options 3.
Return to School Guidelines
- A study suggests that children with streptococcal pharyngitis who have received a single dose of amoxicillin may return to school as early as 12 hours later, provided they are afebrile and show improvement in symptoms 4.
- However, it is essential to note that the decision to return to school should be made on a case-by-case basis, taking into account the individual child's condition and the school's policies.
Rapid Strep Testing
- Rapid antigen-detection tests (RADT) are commonly used for the diagnosis of streptococcal pharyngitis, but may yield false positive results in children who have been recently treated for the condition 5.
- In such cases, throat culture may be a more reliable diagnostic method to confirm the presence of infection 5.