What is the recommended treatment for strep (streptococcal pharyngitis) in a 10-month-old?

Treatment of Streptococcal Pharyngitis in a 10-Month-Old

For a 10-month-old with confirmed streptococcal pharyngitis, treat with oral amoxicillin 50 mg/kg once daily (maximum 1,000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days. 1

First-Line Treatment Approach

• Amoxicillin is the preferred oral agent for young children due to better palatability of the suspension compared to penicillin V, while maintaining equal efficacy 2, 1
• The 10-day course is essential to completely eradicate the organism and prevent acute rheumatic fever, even if symptoms resolve earlier 1, 3
• Penicillin V remains an acceptable alternative at 250 mg two to three times daily for 10 days, though taste acceptance is typically lower in infants 2, 1

Alternative if Compliance is Uncertain

• Intramuscular benzathine penicillin G as a single dose of 600,000 units should be used if you doubt the family's ability to complete the full 10-day oral course 1, 3
• This single-injection approach guarantees complete treatment and is particularly valuable in this age group where medication administration can be challenging 1

Critical Diagnostic Confirmation

• Do not treat empirically—confirm the diagnosis with rapid antigen detection test (RADT) first 1, 4
• If the RADT is negative, obtain a backup throat culture before treating, as RADTs have lower sensitivity in children 2, 1
• A positive RADT is diagnostic and requires no confirmatory culture 1

Important Caveats for This Age Group

• Streptococcal pharyngitis is uncommon in children under 3 years of age, so ensure you have confirmed the diagnosis rather than treating a viral illness 4
• The child becomes non-contagious after 24 hours of antibiotic therapy 5
• Avoid aspirin for fever control due to Reye syndrome risk; use acetaminophen or ibuprofen instead 1, 3

If Penicillin Allergy Exists

• For non-anaphylactic penicillin allergy: use cephalexin 20 mg/kg twice daily (maximum 500 mg per dose) for 10 days 3
• For anaphylactic penicillin allergy: use clindamycin 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days 3
• Azithromycin should be used cautiously due to significant macrolide resistance in some U.S. regions 5, 4

Follow-Up Considerations

• Do not perform routine post-treatment cultures if the child is asymptomatic 2, 1, 3
• Re-evaluate only if symptoms persist beyond 48-72 hours after starting antibiotics or if symptoms recur shortly after completing treatment 3, 4