From the Guidelines
For strep throat in a two-year-old boy, the first-line antibiotic therapy is amoxicillin, given at a dose of 50 mg/kg once daily (maximum 1000 mg) for 10 days, as recommended by the Infectious Diseases Society of America 1. This recommendation is based on the strongest and most recent evidence, which prioritizes the use of amoxicillin due to its proven efficacy, safety, and narrow spectrum of activity.
- The dose of amoxicillin can also be administered as 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days.
- If the child has a penicillin allergy that is not severe, cephalexin can be used at 20 mg/kg/dose twice daily (maximum 500 mg/dose) for 10 days, as an alternative option 1.
- For children with severe penicillin allergy, azithromycin is recommended at 12 mg/kg once daily (maximum 500 mg) for 5 days, or clindamycin at 7 mg/kg/dose three times daily (maximum 300 mg/dose) for 10 days, as secondary options 1. It is essential to complete the full course of antibiotics, even if symptoms improve within a few days, to prevent complications like rheumatic fever.
- The child should also rest, drink plenty of fluids, and may take acetaminophen or ibuprofen for pain and fever.
- Strep throat is caused by group A Streptococcus bacteria, and prompt antibiotic treatment helps prevent complications and reduces contagiousness within 24 hours of starting therapy. The American Heart Association also recommends amoxicillin as a first-line treatment for streptococcal pharyngitis, with a dose of 50 mg/kg once daily (maximum 1 g) for 10 days 1.
- The use of benzathine penicillin G, oral penicillin V, and other antibiotics may also be considered, but amoxicillin remains the preferred choice due to its efficacy and safety profile.
From the FDA Drug Label
Pharyngitis/Tonsillitis The recommended dose of azithromycin for children with pharyngitis/tonsillitis is 12 mg/kg once daily for 5 days.
PEDIATRIC DOSAGE GUIDELINES FOR PHARYNGITIS/TONSILLITIS (Age 2 years and above, see PRECAUTIONS—Pediatric Use.)
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. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx
The antibiotic therapies for streptococcal pharyngitis in a two-year-old male child are:
- Azithromycin: 12 mg/kg once daily for 5 days 2
- Penicillin: by the intramuscular route, which is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever 2
From the Research
Antibiotic Therapies for Streptococcal Pharyngitis
- The recommended first-line therapy for streptococcal pharyngitis is a 10-day course of penicillin V, usually given 2 or 3 times per day 3.
- Alternatives to penicillin V include other penicillins, macrolides, and cephalosporins 3.
- Cephalosporins may provide somewhat higher bacteriologic eradication rates than penicillin V 3.
- Two third-generation cephalosporins, cefdinir and cefpodoxime proxetil, are approved for use in a more convenient 5-day dosing schedule 3.
Considerations for Children
- Palatability is an important consideration when prescribing antibiotics to children 3.
- Cefdinir may offer an alternative to penicillin V for children with streptococcal pharyngitis, particularly when compliance is a clinical concern 3.
- A 3-day azithromycin regimen has been compared to a 10-day penicillin V regimen for treatment of acute group A streptococcal pharyngitis in children, with similar clinical efficacy but lower bacteriologic eradication rates 4.
Other Antibiotic Options
- Clarithromycin has been shown to be as effective and well-tolerated as penicillin in the treatment of streptococcal pharyngitis 5.
- Amoxicillin is also a first-line treatment option for streptococcal pharyngitis 6.
- Patients allergic to penicillin can be treated with first-generation cephalosporins, clindamycin, or macrolide antibiotics 6.