What are the doses and brand names in Dubai for azithromycin, erythromycin, and amoxicillin-clavulanic acid (Augmentin) for the treatment of Group A beta-hemolytic streptococcal (GABHS) pharyngitis, and which one is preferred?

Antibiotic Dosing for GABHS Pharyngitis

For Group A beta-hemolytic streptococcal (GABHS) pharyngitis, amoxicillin 500 mg twice daily for 10 days is the recommended first-line treatment due to its efficacy, safety profile, and cost-effectiveness. 1

Recommended Antibiotic Regimens for GABHS Pharyngitis

Amoxicillin (First-line therapy)

• Dosage: 500 mg twice daily for 10 days (adults)
• Alternative dosing: 50 mg/kg once daily (max 1000 mg) or 25 mg/kg twice daily (max 500 mg per dose) for 10 days 1
• Brand names in Dubai: Amoxil, Moxacin, Amoxicare, Amoxipen

Amoxicillin-Clavulanic Acid

• Dosage: Standard adult dose is 875/125 mg twice daily or 500/125 mg three times daily for 10 days
• Brand names in Dubai: Augmentin, Clavumox, Amoclav, Megamox
• Note: Not typically first-line for uncomplicated GABHS pharyngitis but may be considered when broader coverage is needed

Azithromycin (For penicillin-allergic patients)

• Dosage: 12 mg/kg once daily (max 500 mg) for 5 days 1
• Brand names in Dubai: Zithromax, Azithrocin, Zithrogen, Azomycin

Erythromycin (Alternative for penicillin-allergic patients)

• Dosage: 20-40 mg/kg/day divided into 2-4 doses (max 1 g/day) for 10 days
• Brand names in Dubai: Erythrocin, E-Mycin, Erymax

Treatment Selection Algorithm

1. First-line treatment: Amoxicillin

   • Preferred due to excellent efficacy, good taste (improving compliance), and low cost 1, 2
   • Complete 10-day course is essential to prevent acute rheumatic fever 1

2. For penicillin-allergic patients:

   • Non-severe allergy: Consider cephalosporins
   • Severe allergy (anaphylaxis, angioedema): Use macrolides:
     • Azithromycin (preferred due to shorter 5-day course, improving compliance) 1, 3
     • Erythromycin (alternative option)

3. For treatment failures with amoxicillin:

   • Consider azithromycin or cephalosporins 4

Important Clinical Considerations

• Diagnosis confirmation: Use rapid antigen detection test (RADT) and/or throat culture before initiating antibiotics 1

• Centor Criteria should guide testing decisions:

  • Tonsillar exudates
  • Tender anterior cervical lymph nodes
  • Lack of cough
  • Fever
  • Score ≥3 warrants testing; scores 0-2 suggest viral etiology 1

• Treatment duration: 10-day course is critical for beta-lactams to prevent rheumatic fever; azithromycin requires only 5 days 1

• Compliance considerations: Once-daily amoxicillin (50 mg/kg/day) may improve compliance while maintaining efficacy 2

Cautions and Pitfalls

• Avoid antibiotics in likely viral pharyngitis (cough, rhinorrhea, hoarseness, oral ulcers) 1
• Macrolide resistance exists in some regions; be aware of local resistance patterns 5
• Bacteriologic eradication rates with azithromycin (65%) may be lower than with penicillin (82%), though clinical success rates are similar 6
• Complete the full antibiotic course even if symptoms improve quickly to prevent complications 1
• Overdiagnosis of GABHS pharyngitis is common, leading to unnecessary antibiotic use 4