Best Medication for Streptococcal Pharyngitis in Children
Amoxicillin is the first-line treatment for children with streptococcal pharyngitis due to its proven efficacy, safety, narrow spectrum of activity, and excellent palatability for pediatric patients. 1, 2
First-Line Treatment Options
For children without penicillin allergy:
- Amoxicillin: 50 mg/kg once daily (maximum = 1,000 mg) or 25 mg/kg twice daily (maximum = 500 mg) for 10 days 1, 2
- Penicillin V: 250 mg two or three times daily for 10 days 1
- Penicillin G benzathine (intramuscular): Single dose of 600,000 units for children <60 lb (27 kg) or 1,200,000 units for children ≥60 lb - recommended for patients unlikely to complete a full 10-day oral course 1, 2
Alternative Options for Penicillin-Allergic Patients
For children with non-anaphylactic penicillin allergy:
- Cephalexin (Keflex): 20 mg/kg per dose twice daily (maximum = 500 mg per dose) for 10 days 1, 3
- Cefadroxil: 30 mg/kg once daily (maximum = 1 g) for 10 days 1, 3
For children with anaphylactic penicillin allergy:
- Clindamycin: 7 mg/kg per dose three times daily (maximum = 300 mg per dose) for 10 days 1, 3
- Azithromycin: 12 mg/kg once daily (maximum = 500 mg) for 5 days 1, 4
- Clarithromycin: 7.5 mg/kg per dose twice daily (maximum = 250 mg per dose) for 10 days 1, 3
Treatment Duration Considerations
- The standard 10-day course for penicillin and most other antibiotics is recommended to ensure complete eradication of the organism and prevent rheumatic fever 1, 2
- Azithromycin is the exception with a shorter 5-day course due to its longer half-life 1, 4
- While some studies suggest shorter duration therapy (5-7 days) may be effective 5, 6, the most authoritative guidelines still recommend the full 10-day course for beta-lactam antibiotics to prevent complications 1, 2
Adjunctive Therapy
- Acetaminophen or NSAIDs can be used for moderate to severe symptoms or to control high fever 1, 2
- Aspirin should be avoided in children due to the risk of Reye syndrome 1, 2
- Corticosteroids are not recommended for routine treatment of streptococcal pharyngitis 1, 7
Common Pitfalls to Avoid
- Treating likely viral pharyngitis with antibiotics - look for clinical features suggesting viral etiology (cough, rhinorrhea, hoarseness, oral ulcers) 1, 2
- Using macrolides (azithromycin, clarithromycin) in areas with high resistance rates - resistance varies geographically 1, 8
- Failing to complete the full course of antibiotics, which can lead to treatment failure and complications 1, 2
- Using tetracyclines or sulfonamides, which have high rates of resistance 1
Special Considerations
- Testing is generally not recommended in children younger than three years unless they have risk factors, such as an older sibling with the illness 1
- For recurrent streptococcal pharyngitis, consider whether the patient is a chronic carrier experiencing viral infections rather than true recurrent streptococcal infections 1, 3
- Follow-up post-treatment testing is not routinely recommended unless symptoms persist 1