From the Guidelines
Treatment options for pharyngitis in a 12-month-old infant are limited to symptomatic relief with acetaminophen or ibuprofen, as antibiotics are only recommended for bacterial causes, such as Group A Streptococcus (GAS) pharyngitis, which is uncommon in infants under 3 years old.
Symptomatic Relief
- Acetaminophen can be used to reduce fever and pain, with a recommended dose of 15 mg/kg/dose every 4-6 hours as needed, not to exceed 5 doses in 24 hours 1.
- Ibuprofen can also be used to reduce fever and pain, with a recommended dose of 10 mg/kg/dose every 6-8 hours as needed, not to exceed 3 doses in 24 hours 1.
Antibiotic Treatment
- Penicillin is the first-line treatment for GAS pharyngitis, but it is not recommended for infants under 3 years old unless a bacterial cause is confirmed 1.
- Amoxicillin can be used as an alternative to penicillin in younger children, but it is not recommended as a first-line treatment due to the risk of severe rash in patients with Epstein-Barr virus infection 1.
Important Considerations
- Aspirin should not be used in children due to the risk of Reye syndrome 1.
- Corticosteroids are not recommended for the treatment of pharyngitis in children due to the potential for adverse effects and the self-limited nature of the illness 1.
- Topical agents, such as lozenges and sprays, are not recommended for infants due to the risk of choking hazard 1.
From the Research
Treatment Options for Pharyngitis in a 12-month-old Infant
- The treatment of pharyngitis in infants typically depends on the cause of the infection, with viral infections being the most common cause 2.
- For bacterial pharyngitis, such as group A beta-hemolytic streptococcal (GABHS) pharyngitis, antibiotics are recommended to prevent complications like acute rheumatic fever and suppurative complications 3, 4, 5, 6.
- Penicillin is considered the first-line treatment for GABHS pharyngitis, but oral amoxicillin can also be used due to its better palatability 3, 6.
- Macrolides should be reserved for cases of proven allergy to β-lactams, while cephalosporins can be used in patients allergic to penicillin (except for type I hypersensitivity) 3, 6.
- Nonsteroidal anti-inflammatory agents (NSAIAs) can be used to relieve pain in children with pharyngitis, and are preferred over acetaminophen in some cases 5.
Antibiotic Treatment
- A 10-day course of penicillin V is the recommended first-line therapy for streptococcal pharyngitis, but alternatives like amoxicillin, macrolides, and cephalosporins are also available 6.
- Cephalosporins may provide higher bacteriologic eradication rates than penicillin V, and some can be administered twice daily or in a 5-day dosing schedule 6.
- The choice of antibiotic should also consider palatability, as children may prefer certain flavors or formulations over others 6.
Diagnosis and Testing
- A throat culture or rapid antigen detection test is generally necessary to confirm the diagnosis of GABHS pharyngitis, as it cannot be reliably distinguished from other etiologies based on epidemiologic or physical findings alone 4, 6.
- The use of the Centor score to evaluate the risk of streptococcal infection is under debate, and the interpretation of test results may vary considerably 3.