From the Guidelines
For throat angina (streptococcal pharyngitis), the recommended penicillin V dosing regimen is 500 mg orally twice daily for 10 days for adults and adolescents, and 250 mg twice or three times daily for children, as stated in the 2012 update by the Infectious Diseases Society of America 1. The dosage for children can also be calculated as 25-50 mg/kg/day divided into 2-3 doses, especially for smaller children. It is crucial to complete the full 10-day course even if symptoms improve earlier to ensure complete eradication of Group A Streptococcus and prevent complications like rheumatic fever. Some key points to consider when taking penicillin V include:
- Taking it on an empty stomach, 1 hour before or 2 hours after meals, for optimal absorption.
- Being aware of potential allergic reactions, such as a rash, severe diarrhea, or difficulty breathing, and seeking medical attention immediately if these occur.
- Understanding that penicillin V works by interfering with bacterial cell wall synthesis, causing the bacteria to rupture and die, and that it remains the first-line treatment for streptococcal pharyngitis due to its narrow spectrum, effectiveness, and the fact that Group A Streptococcus has not developed resistance to penicillin 1. The evidence from the Infectious Diseases Society of America supports the use of penicillin V as the first-line treatment for streptococcal pharyngitis, citing its efficacy, safety, and narrow spectrum of activity 1.
From the Research
Dosing Regimen for Penicillin V
The dosing regimen for Penicillin V (Phenoxymethylpenicillin) for the treatment of Pharyngitis (Throat Infection) is as follows:
- Penicillin V for 10 days is the standard therapy and is effective in the management of GABHS pharyngitis 2
- The recommended dosage is 250 mg, twice daily for ten days, which affords optimal treatment for children 3
- In some cases, a shorter treatment regimen of 5 days may be considered, with a dosage of 800 mg four times daily 4
- However, it is essential to note that the 10-day regimen is still the preferred treatment, especially in areas where rheumatic fever is prevalent 3
Considerations for Treatment
When considering treatment with Penicillin V, the following factors should be taken into account:
- Compliance with the 10-day treatment regimen can be a challenge, especially in young children 2, 5
- Bacteriologic treatment failures have been documented in up to 35% of GABHS patients treated with penicillin V, particularly in children <6 years old 2
- Alternative treatment options, such as azithromycin, may be considered in cases of penicillin hypersensitivity or suspected non-adherence to the 10-day penicillin regimen 2