What else can be done for a child diagnosed with Group A Streptococcal (GAS) pharyngitis?

Management of Group A Streptococcal (GAS) Pharyngitis in Children

For a child diagnosed with Group A Streptococcal pharyngitis, appropriate antibiotic therapy should be combined with adjunctive treatments to manage symptoms and prevent complications. 1

Antibiotic Treatment Options

• First-line therapy: Penicillin V or amoxicillin for 10 days remains the treatment of choice due to narrow spectrum, low cost, and lack of resistance 1

  • Penicillin V dosing: Children - 250 mg 2-3 times daily; Adolescents - 250 mg 4 times daily or 500 mg twice daily 1
  • Amoxicillin dosing: 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) 1
  • Intramuscular benzathine penicillin G is an option for patients unlikely to complete the full oral course 1

• For penicillin-allergic patients: 2

  • Non-anaphylactic allergy: First-generation cephalosporins for 10 days
    • Cephalexin: 20 mg/kg twice daily (maximum 500 mg per dose) 1
    • Cefadroxil: 30 mg/kg once daily (maximum 1 g) 1
  • Anaphylactic allergy:
    • Clindamycin: 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 1, 3
    • Clarithromycin: 7.5 mg/kg twice daily (maximum 250 mg per dose) for 10 days 1
    • Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days 1

Adjunctive Therapy

• Pain and fever management: Acetaminophen or NSAIDs should be used for moderate to severe symptoms or high fever 1, 4

  • Aspirin should be strictly avoided in children due to risk of Reye syndrome 1, 4

• Hydration: Encourage adequate fluid intake to prevent dehydration 4

• Topical relief: Warm salt water gargles can provide symptomatic relief for children old enough to gargle 4

• Corticosteroids: Not recommended for routine use in GAS pharyngitis 1, 2

Follow-up Considerations

• Routine post-treatment throat cultures are not recommended unless clinically indicated 1

• For recurrent episodes, consider whether the patient is experiencing true recurrent infections or is a chronic carrier with concurrent viral infections 1, 2

• GAS carriers generally do not require antimicrobial therapy as they are unlikely to spread infection and have minimal risk for complications 1

Important Caveats

• Ensure full 10-day course of antibiotics is completed, even if symptoms resolve earlier, to prevent rheumatic fever and other complications 5

• Penicillin should be used with caution in individuals with significant allergies or asthma 5

• The oral route may not be reliable in patients with severe illness, nausea, vomiting, or gastrointestinal motility issues 5

• Tonsillectomy is not recommended solely to reduce the frequency of GAS pharyngitis 1, 2

• Be aware of potential macrolide resistance when prescribing azithromycin or clarithromycin, which varies geographically 2

• Twice-daily dosing of penicillin V (500 mg twice daily) is as effective as four-times-daily dosing and may improve adherence 6