From the Guidelines
The first line treatment for strep throat in children is oral amoxicillin at a dose of 50 mg/kg once daily (maximum 1000 mg) for 10 days, as it has been shown to be effective and has a better taste and once-daily dosing options, which may improve compliance 1. This recommendation is based on the most recent and highest quality study, which prioritizes morbidity, mortality, and quality of life as the outcome. Some key points to consider when treating strep throat in children include:
- The importance of completing the full 10-day course of antibiotics, even if symptoms improve earlier, to prevent complications like rheumatic fever and reduce the risk of treatment failure.
- The use of supportive care, such as adequate hydration, acetaminophen or ibuprofen for pain and fever, and rest, to help manage symptoms and support recovery.
- The consideration of alternative antibiotics, such as clindamycin, azithromycin, or a first-generation cephalosporin, for children with penicillin allergy.
- The need to exclude the diagnosis of GAS pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with nonstreptococcal pharyngitis, which can lead to unnecessary exposure to the expense and hazards of antimicrobial therapy. It is essential to note that the diagnosis of strep throat should be confirmed by culture or RADT, and antimicrobial therapy should be initiated only if the diagnosis is confirmed or if there is a high index of suspicion based on clinical or epidemiological evidence 1.
From the FDA Drug Label
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. The first line treatment for strep throat in children is penicillin.
- The FDA drug label for azithromycin 2 and cefixime 3 both indicate that penicillin is the usual drug of choice for treating Streptococcus pyogenes infections.
- Azithromycin and cefixime may be used as alternative treatments in certain cases, but penicillin is the preferred first-line treatment.
From the Research
First-Line Treatment for Strep Throat in Children
The first-line treatment for strep throat in children is typically a 10-day course of penicillin V, given 2 or 3 times per day 4. This is because Group A beta-hemolytic streptococcus (GABHS) is sensitive to penicillins and cephalosporins.
Alternative Treatment Options
Alternative treatment options include:
- Other penicillins
- Macrolides (although resistance has been identified in some geographic regions) 4
- Cephalosporins, which may provide higher bacteriologic eradication rates than penicillin V 4, 5
- A 5-day course of certain cephalosporins, such as cefdinir or cefpodoxime proxetil, which may increase adherence to the full course of therapy 4, 6
Considerations for Treatment
When prescribing antibiotics to children, considerations include:
- Palatability: children may prefer the taste of certain antibiotics, such as cefdinir, over others 4
- Compliance: a 5-day course of certain cephalosporins may be more convenient and increase the likelihood of adherence to the full course of therapy 4, 6
- Resistance: azithromycin and clarithromycin have significant resistance in some parts of the United States 7
Treatment Duration and Efficacy
Studies have compared the efficacy of different treatment durations, including:
- 10 days of penicillin V vs 5 days or 10 days of cefpodoxime therapy in children, with cefpodoxime showing superior bacteriologic efficacy 6
- 10 days of penicillin therapy, which may not be the best therapeutic choice for all pediatric patients, with cephalosporins potentially being preferable in some cases 5