What is the recommended treatment and dosage of amoxicillin for a 9-year-old boy with strep throat?

Treatment for Strep Throat in a Nine-Year-Old Boy

For a 9-year-old boy with strep throat, the recommended treatment is amoxicillin at a dose of 50-75 mg/kg/day divided into 2 doses for 10 days. 1, 2

First-Line Treatment

• Amoxicillin is the preferred first-line treatment for Group A Streptococcal (GAS) pharyngitis in children 2
• The recommended dosage is:
  • 50-75 mg/kg/day divided into 2 doses (preferred) 1, 2
  • Maximum daily dose should not exceed 1,000 mg per day 2
• Treatment duration should be 10 days to prevent acute rheumatic fever 3, 4

Administration Guidelines

• Administer amoxicillin at the start of a meal to minimize gastrointestinal intolerance 3
• The suspension should be shaken well before using 3
• Even if symptoms resolve earlier, the full 10-day course must be completed to prevent complications 2, 4

Alternative Dosing Options

• Once-daily dosing (750 mg for children <40 kg or 1000 mg for children ≥40 kg) has been shown to be non-inferior to twice-daily dosing in a large clinical trial 5
• This alternative dosing may improve adherence in some cases 5

Treatment Alternatives for Penicillin Allergy

For children with penicillin allergy, alternative options include:

• For non-type I hypersensitivity reactions:
  • Cephalexin: 75-100 mg/kg/day in 3-4 doses 1, 2
  • Cefdinir or cefpodoxime: These may offer better palatability and shorter treatment duration (5 days) 4
• For type I hypersensitivity reactions:
  • Clindamycin: 40 mg/kg/day in 3 doses 1, 6
  • Macrolides: Reserved only for confirmed penicillin allergy 6

Monitoring and Follow-up

• Assess response to therapy after 48-72 hours 3
• If no improvement occurs within 48-72 hours, reevaluate the diagnosis 1
• If treatment failure occurs with amoxicillin, consider:
  • Lack of adherence to the full 10-day regimen 7
  • Reexposure to infected family members 7
  • Need for alternative antibiotics such as cephalosporins 7

Common Pitfalls to Avoid

• Underdosing amoxicillin can lead to treatment failure 7
• Stopping antibiotics early when symptoms improve increases risk of rheumatic fever 3, 4
• Not confirming diagnosis with rapid strep test or throat culture before treatment 8
• Using broad-spectrum antibiotics unnecessarily when amoxicillin is effective 6

Special Considerations

• If the child has impaired renal function, dose adjustment may be necessary 3
• For recurrent infections or treatment failures, amoxicillin-clavulanate may be considered 2
• Local antibiotic resistance patterns should be considered when selecting therapy 2