What is the treatment for pharyngitis in a 10-year-old?

Treatment of Pharyngitis in a 10-Year-Old Child

For a 10-year-old child with pharyngitis, diagnosis with a rapid antigen detection test (RADT) or throat culture should be performed before initiating antibiotic treatment, and if Group A Streptococcus (GAS) is confirmed, oral penicillin V or amoxicillin for 10 days is the recommended first-line treatment.

Diagnostic Approach

• Pharyngitis in children is most commonly viral, with GAS causing only 25-40% of cases in school-aged children 1
• Clinical features suggestive of GAS pharyngitis include:
  • Sudden onset sore throat, fever, headache, nausea/vomiting 1
  • Tonsillopharyngeal erythema or exudates, soft palate petechiae, swollen uvula 1
  • Tender enlarged anterior cervical lymph nodes 1
• Features suggesting viral etiology include cough, conjunctivitis, coryza, hoarseness, and diarrhea 1
• Clinical features alone cannot reliably diagnose GAS pharyngitis; laboratory confirmation is essential 1
• RADT should be performed in children with clinical symptoms suggestive of GAS 1, 2
• A positive RADT is diagnostic and does not require backup culture 2
• A negative RADT in children should be followed by a throat culture to confirm 1, 2

First-Line Treatment for GAS Pharyngitis

• If GAS is confirmed, the recommended treatment options are:
  • Oral penicillin V: 250 mg four times daily or 500 mg twice daily for 10 days 2, 3
  • Amoxicillin: 50 mg/kg once daily (maximum 1,000 mg) for 10 days, which may enhance adherence 2, 4
• A full 10-day course of antibiotics is necessary to prevent acute rheumatic fever, even if symptoms resolve earlier 3, 4
• Treatment should be initiated within 9 days of symptom onset to effectively prevent acute rheumatic fever 1

Treatment for Penicillin-Allergic Patients

• For non-anaphylactic penicillin allergy, first-generation cephalosporins (e.g., cephalexin) for 10 days 2
• For patients with severe penicillin allergy, erythromycin 30-50 mg/kg/day in divided doses (not exceeding 4g/day) for 10 days 5
• Macrolide resistance should be considered in areas where it is prevalent 6

Symptomatic Treatment

• Acetaminophen or NSAIDs for moderate to severe symptoms or high fever 2
• Avoid aspirin in children due to risk of Reye syndrome 2
• Adequate hydration and rest should be encouraged 7

Common Pitfalls to Avoid

• Treating without confirming diagnosis through testing, as clinical features alone cannot reliably distinguish between viral and bacterial pharyngitis 2, 7
• Prescribing antibiotics for viral pharyngitis, which contributes to antimicrobial resistance 1, 8
• Using broad-spectrum antibiotics unnecessarily when narrow-spectrum options (penicillin, amoxicillin) are effective 2
• Shortening the duration of antibiotic therapy to less than 10 days, which may not prevent acute rheumatic fever 4, 7

Follow-Up Recommendations

• Routine post-treatment throat cultures are not recommended unless symptoms persist or recur 2
• If symptoms worsen after antibiotic initiation or persist for 5 days after starting treatment, the patient should be reevaluated 8
• Parents should be informed about the expected duration of symptoms and signs of possible complications 1