What is the recommended dose and frequency of amoxicillin (amoxicillin) for a diabetic adult with streptococcal pharyngitis?

From the Guidelines

For an adult with diabetes and strep pharyngitis, the recommended treatment is amoxicillin 50 mg/kg once daily (max = 1000 mg) for 10 days, as this dosing has been shown to be effective in treating GAS pharyngitis 1. This dosing is based on the patient's weight, with a maximum dose of 1000 mg per day. Alternatively, amoxicillin can be given at a dose of 25 mg/kg (max = 500 mg) twice daily for 10 days 1. It's essential to complete the full 10-day course even if symptoms improve earlier to ensure complete eradication of Group A Streptococcus and prevent complications like rheumatic fever. The medication can be taken with or without food, though taking it with food may reduce stomach upset. If the patient has a penicillin allergy, alternatives include cephalexin 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days or, in case of severe penicillin allergy, azithromycin 12 mg/kg once daily (max = 500 mg) for 5 days 1. Amoxicillin is effective against strep throat because it inhibits bacterial cell wall synthesis, and the 10-day duration helps ensure the infection is fully cleared, which is particularly important in diabetic patients who may have slightly compromised immune function. Key points to consider when selecting an antimicrobial for treatment of GAS pharyngitis include efficacy, safety, antimicrobial spectrum, dosing schedule, compliance with therapy, and cost 1. Penicillin and its congeners, such as amoxicillin, remain the treatment of choice for GAS pharyngitis due to their proven efficacy and safety, narrow spectrum, and low cost 1.

Some important considerations for diabetic patients with strep pharyngitis include:

• The importance of completing the full 10-day course of antibiotics to ensure complete eradication of the infection
• The potential for compromised immune function in diabetic patients, which may affect the course of the infection
• The need to monitor blood sugar levels closely while taking antibiotics, as some antibiotics may affect blood sugar control
• The importance of practicing good hygiene, such as washing hands frequently, to prevent the spread of the infection to others.

Overall, the treatment of strep pharyngitis in diabetic adults should be guided by the principles of evidence-based medicine, with a focus on using effective, safe, and cost-effective treatments to improve patient outcomes and prevent complications.

From the FDA Drug Label

In some infections, therapy may be required for several weeks. It may be necessary to continue clinical and/or bacteriological follow-up for several months after cessation of therapy. 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 ... Ear/Nose/Throat ... Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours Table 1 ... Ear/Nose/Throat ... Severe 875 mg every 12 hours or 500 mg every 8 hours

The recommended amoxicillin dose and frequency for a diabetic adult with strep pharyngitis is:

• Mild/Moderate: 500 mg every 12 hours or 250 mg every 8 hours
• Severe: 875 mg every 12 hours or 500 mg every 8 hours Treatment should be continued for at least 10 days to prevent the occurrence of acute rheumatic fever 2

From the Research

Amoxicillin Dose and Frequency for Diabetic Adult with Strep Pharyngitis

• The recommended dose and frequency of amoxicillin for strep pharyngitis is not explicitly stated in the provided studies for diabetic adults specifically 3, 4, 5, 6, 7.
• However, according to the studies, amoxicillin is equally effective as penicillin and more palatable for the treatment of strep pharyngitis 3.
• A study comparing once-daily amoxicillin with conventional twice-daily amoxicillin for group A streptococcal pharyngitis found that once-daily amoxicillin is not inferior to twice-daily amoxicillin 5.
• The American Family Physician recommends a 10-day course of penicillin or amoxicillin for the treatment of strep pharyngitis 3, 4.
• Another study suggests that carbacephem may be more effective than penicillin for symptom resolution in adults and children, but the evidence is of low certainty 6.

Considerations for Diabetic Adults

• There is no specific guidance in the provided studies on adjusting amoxicillin dose or frequency for diabetic adults with strep pharyngitis 3, 4, 5, 6, 7.
• However, it is essential to consider the individual patient's health status, including their diabetes management, when prescribing antibiotics 7.

Antibiotic Treatment

• The choice of antibiotic and duration of treatment should be based on clinical guidelines and the patient's specific needs 3, 4, 6, 7.
• Antibiotics with narrow spectrums of activity, such as penicillin and amoxicillin, are generally recommended for the treatment of strep pharyngitis 3, 4, 7.