From the Guidelines
The most appropriate oral antibiotic for treating group A streptococcal pharyngitis in patients without penicillin allergy is amoxicillin, 50 mg per kg once daily (maximum = 1,000 mg), for 10 days, as recommended by the IDSA guidelines with strong, high-quality evidence 1. When considering oral antibiotics, the choice depends on the patient's allergy status and the specific infection being treated. For group A streptococcal pharyngitis, the following options are recommended:
- For patients without penicillin allergy:
- Penicillin V, oral, with a dose of 250 mg two or three times daily for children, and 250 mg four times daily or 500 mg twice daily for adolescents and adults, for 10 days, with strong, high-quality evidence 1.
- Amoxicillin, oral, with a dose of 50 mg per kg once daily (maximum = 1,000 mg), for 10 days, with strong, high-quality evidence 1.
- For patients with penicillin allergy:
- Cephalexin (Keflex), oral, with a dose of 20 mg per kg per dose twice daily (maximum = 500 mg per dose), for 10 days, with strong, high-quality evidence 1.
- Clindamycin, oral, with a dose of 7 mg per kg per dose three times daily (maximum = 300 mg per dose), for 10 days, with strong, moderate-quality evidence 1. It is essential to consider local resistance patterns, patient allergies, and comorbidities when selecting an antibiotic. Patients should complete the full course of treatment, even if symptoms improve, and report any worsening symptoms or lack of improvement after 48-72 hours of treatment.
From the Research
Oral Antibiotic Options
The choice of oral antibiotic (abx) depends on the type of infection being treated. Based on the provided studies, the following options are available:
- Azithromycin: effective against skin and skin-structure infections, including those caused by Staphylococcus aureus and Streptococcus spp. 2, 3
- Cephalexin: effective against streptococcal and staphylococcal skin infections, with cure rates of 90% or higher 4
- Cefdinir: comparable to cephalexin in the treatment of mild to moderate uncomplicated skin and skin structure infections, with clinical cure rates of 89% 5
- Amoxicillin: effective against group A beta-hemolytic streptococcal (GABHS) pharyngitis, with once-daily therapy being as effective as penicillin V therapy given three times a day 6
Key Considerations
When choosing an oral antibiotic, consider the following factors:
- Type of infection: different antibiotics are effective against different types of infections
- Patient compliance: once-daily therapy may improve patient compliance, as seen with azithromycin and amoxicillin 2, 6
- Side effects: azithromycin and cefdinir were found to be well-tolerated, with mild or moderate gastro-intestinal complaints being the most common side effects 3, 5
- Cost: cost factors may play an important role in choosing one antibiotic over another, as seen with cephalexin 4