From the Guidelines
The recommended treatment for a 9-year-old patient in Canada with streptococcal infection is oral penicillin V at a dose of 250 mg twice daily or 3 times daily for 10 days, as it is the first-line treatment and Group A streptococcus remains universally susceptible to penicillin 1.
Key Considerations
- The patient's weight is not explicitly mentioned, but according to the guideline, for children, the dose is 250 mg twice daily or 3 times daily for 10 days 1.
- If the patient has a penicillin allergy, alternatives include amoxicillin (50 mg/kg once daily for 10 days, maximum 1000 mg/day) or cephalexin (20 mg/kg/dose twice daily, maximum 500 mg/dose) for 10 days 1.
- It is essential to complete the full course of antibiotics even if symptoms improve within a few days to prevent complications like rheumatic fever or post-streptococcal glomerulonephritis.
Supportive Care
- Adequate hydration is crucial to help the patient recover from the infection.
- Acetaminophen or ibuprofen can be used for fever and pain relief.
- Rest is also essential to help the patient's body fight the infection.
Importance of Prompt Treatment
- Treatment should begin promptly after diagnosis to reduce symptoms and prevent complications.
- Group A streptococcus remains universally susceptible to penicillin, making it the first-line treatment for strep infections in children 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.
The recommended treatment for a 9-year-old patient in Canada with streptococcal (strep) infection is amoxicillin for at least 10 days to prevent acute rheumatic fever, and treatment should continue for a minimum of 48 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication is obtained 2.
- The dosage for a pediatric patient aged 3 months and older is based on weight, with a recommended dosage of 25 mg/kg/day in divided doses every 12 hours or 20 mg/kg/day in divided doses every 8 hours for mild to moderate infections, and 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours for severe infections.
From the Research
Recommended Treatment for Strep Infection in a 9-Year-Old in Canada
The recommended treatment for a 9-year-old patient in Canada with streptococcal (strep) infection is as follows:
- Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days 3
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 3
- Azithromycin and clarithromycin are not recommended due to significant resistance in some parts of the United States, but may be considered in certain cases 3, 4
- A daily dose of amoxicillin is not inferior to other dosing schedules of the same antibiotic or penicillin V 5
Diagnosis and Testing
- Guidelines recommend using clinical decision rules to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 3
- After a negative rapid antigen test result, a throat culture is recommended in children and adolescents 3
Considerations
- Fever, tonsillar exudate, cervical lymphadenitis, and patient ages of 3 to 15 years increase clinical suspicion of strep infection 3
- A cough is more suggestive of a viral etiology 3
- Steroids are not recommended for symptomatic treatment 3
- Patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 3