Can we give amoxicillin (amoxacillin) instead of penicillin V in sore throat?

From the Guidelines

Yes, amoxicillin can be used instead of penicillin V for treating streptococcal pharyngitis (strep throat). For adults, the typical dosage is 500 mg three times daily for 10 days, while children typically receive 50 mg/kg/day divided into three doses for 10 days (maximum 500 mg per dose) 1. Amoxicillin is effective against Group A Streptococcus, the most common bacterial cause of sore throat, and offers some advantages over penicillin V including better absorption, broader spectrum of activity, and a more convenient dosing schedule (three times daily versus four times daily for penicillin V). The improved taste of amoxicillin suspension also enhances compliance in children. However, amoxicillin has a broader spectrum than necessary for strep throat, which could contribute to antibiotic resistance. Patients with penicillin allergy should not receive amoxicillin as cross-reactivity exists. For those with severe penicillin allergy, macrolides like azithromycin or clindamycin are alternative options.

Some key points to consider when using amoxicillin for streptococcal pharyngitis include:

• The dosage and duration of treatment are crucial for effective eradication of the bacteria and prevention of complications such as acute rheumatic fever 1.
• Amoxicillin is generally well-tolerated, but patients should be monitored for signs of allergic reactions or other adverse effects 1.
• The use of amoxicillin or other antibiotics should be guided by a thorough diagnosis and consideration of the patient's medical history, including any allergies or previous reactions to antibiotics 1.
• Alternative treatments, such as macrolides or clindamycin, may be necessary for patients with severe penicillin allergy or other contraindications to amoxicillin 1.
• The choice of antibiotic should be based on the most recent and highest-quality evidence, taking into account factors such as efficacy, safety, and cost-effectiveness 1.

From the FDA Drug Label

Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae.

Yes, amoxicillin can be given instead of penicillin V in sore throat, as it is indicated for the treatment of upper respiratory tract infections, including those caused by Streptococcus species, which are commonly associated with sore throat 2.

From the Research

Amoxicillin as an Alternative to Penicillin V in Sore Throat

• The provided studies do not directly compare amoxicillin to penicillin V in the treatment of sore throat.
• However, a study 3 mentions that amoxicillin-clavulanate potassium provides superior bacteriologic and clinical cure rates compared to oral penicillin, suggesting that amoxicillin may be a viable alternative.
• Another study 4 compares the efficacy of amoxicillin/clavulanate to penicillin V and clarithromycin in the treatment of acute group A streptococcal tonsillopharyngitis, finding that amoxicillin/clavulanate had a similar clinical efficacy to penicillin V and was more effective in eradicating the bacteria.

Considerations for Using Amoxicillin

• The decision to use amoxicillin instead of penicillin V should be based on factors such as patient allergies, bacteriologic and clinical efficacy, frequency of administration, duration of therapy, potential side effects, compliance, and cost 3.
• It is essential to note that the studies provided do not specifically address the use of amoxicillin as a direct replacement for penicillin V in sore throat treatment, but rather as part of a combination therapy (amoxicillin-clavulanate) or in comparison to other antibiotics.

Bacteriologic and Clinical Efficacy

• A study 5 found that penicillin V was effective in treating sore throat caused by group A beta-hemolytic streptococci (GABHS), with a significant difference in resolution of sore throat and fever in GABHS-positive patients.
• Another study 6 compared azithromycin to penicillin V in the treatment of streptococcal pharyngitis, finding that both treatments were effective, but with some differences in eradication rates and side effects.
• The efficacy of amoxicillin in treating sore throat caused by GABHS is not directly addressed in the provided studies, but its use as part of a combination therapy (amoxicillin-clavulanate) shows promise 3, 4.