From the Guidelines
The pediatric treatment for Group A beta-hemolytic streptococcal (GABHS) infection is typically a 10-day course of antibiotics, such as penicillin or amoxicillin.
Treatment Options
- For individuals without penicillin allergy, options include:
- Penicillin V, oral: 250 mg twice daily or 3 times daily for children, 250 mg 4 times daily or 500 mg twice daily for adolescents and adults, for 10 days 1
- Amoxicillin, oral: 50 mg/kg once daily (max = 1000 mg) or 25 mg/kg (max = 500 mg) twice daily, for 10 days 1
- Benzathine penicillin G, intramuscular: 600,000 U for children <27 kg, 1,200,000 U for children ≥27 kg, as a single dose 1
- For individuals with penicillin allergy, options include:
- Cephalexin, oral: 20 mg/kg/dose twice daily (max = 500 mg/dose), for 10 days 1
- Clindamycin, oral: 7 mg/kg/dose 3 times daily (max = 300 mg/dose), for 10 days 1
- Azithromycin, oral: 12 mg/kg once daily (max = 500 mg), for 5 days, although resistance to this agent is well-known and varies geographically and temporally 1
Duration of Treatment
While some studies suggest that short-course antibiotics may be effective for GABHS pharyngitis, a 10-day course of standard-dose penicillin is generally recommended 1. However, oral cephalosporins or high-dose penicillin given four times daily may be alternatives 1.
Importance of Accurate Diagnosis
Accurate diagnosis of GABHS pharyngitis is crucial to prevent inappropriate antimicrobial therapy and reduce the risk of acute rheumatic fever and other complications 1.
From the Research
Pediatric Treatment for Group A Beta-Hemolytic Streptococcal (GABHS) Infection
The treatment for GABHS infection in pediatric patients typically involves antibiotic therapy. The following points outline the recommended treatment approaches:
- The first-line therapy for streptococcal pharyngitis is a 10-day course of penicillin V, usually given 2 or 3 times per day 2.
- For patients allergic to penicillin, erythromycin is recommended as an alternative 3, 4.
- Cephalosporins, such as cefdinir and cefpodoxime proxetil, may be used as alternatives to penicillin V, with some offering a more convenient 5-day dosing schedule 2, 4.
- The American Academy of Pediatrics and American Heart Association recommend penicillin as the first-line therapy for GABHS infections, with erythromycin as an alternative for patients allergic to penicillin 3.
- A 10-day treatment course with oral cephalosporins or erythromycin is recommended as a suitable alternative in patients who are allergic to penicillin 4.
Diagnosis and Management
Diagnosis of GABHS infection is crucial for appropriate treatment. The following points highlight the importance of diagnosis:
- A throat culture or rapid antigen detection test is generally necessary to confirm the diagnosis of streptococcal pharyngitis 3, 2.
- The use of throat cultures and/or rapid GABHS detection tests in the office is strongly advocated to reduce antibiotic overprescribing 3.
- Accurate diagnosis of GABHS infection is important because it is the only common form of acute pharyngotonsillitis for which antibiotic therapy is definitely indicated 5.
Treatment Duration and Compliance
Treatment duration and compliance are essential for effective management of GABHS infection:
- Treatment duration with penicillin should be 10 days to optimize cure in GABHS infections 3.
- A 5-day regimen is possible and approved by the United States Food and Drug Administration for cefpodoxime and azithromycin 3.
- Palatability is an important consideration when prescribing antibiotics to children, with cefdinir offering a pleasant strawberry-cream taste that may improve compliance 2.