From the Guidelines
For a child with strep throat who has an anaphylactic reaction to beta-lactam antibiotics, the first-line treatment is azithromycin, given its strong, moderate recommendation and the most recent guideline evidence available 1.
Key Considerations
- The recommended dosage of azithromycin is 12 mg/kg once daily (maximum 500 mg) for 5 days, as outlined in the 2012 update by the Infectious Diseases Society of America 1.
- It is crucial to confirm the diagnosis of strep throat with a rapid strep test or throat culture before initiating antibiotic therapy to ensure appropriate treatment and prevent unnecessary antibiotic use.
- Treatment should commence as soon as possible to prevent complications such as rheumatic fever, reduce symptom duration, and decrease contagiousness.
Alternative Options
- Clindamycin is an alternative option, recommended at 7 mg/kg three times daily (maximum 300 mg per dose) for 10 days, especially if there are concerns about macrolide resistance in the region 1.
- The choice between azithromycin and clindamycin should consider factors such as resistance patterns, patient tolerance, and the potential for side effects.
Supportive Care
- Alongside antibiotic therapy, supportive care including adequate hydration, rest, and appropriate pain management is essential for the patient's comfort and recovery.
- Monitoring for symptom resolution and potential side effects of the antibiotic is crucial, given the known resistance of GAS to macrolides in some geographic areas 1.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. The recommended dose of azithromycin for children with pharyngitis/tonsillitis is 12 mg/kg once daily for 5 days. NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx
First-line antibiotic treatment for a child with strep throat who has an anaphylactic reaction to beta-lactam antibiotics is azithromycin. The recommended dose is 12 mg/kg once daily for 5 days 2 2.
From the Research
First-Line Antibiotics for Strep Throat with Anaphylactic Reaction to Beta Lactam
- For a child with strep throat who has an anaphylactic reaction to beta-lactam antibiotics, alternative antibiotic options are necessary 3, 4.
- First-generation cephalosporins are recommended for patients with non-anaphylactic allergies to penicillin, but for anaphylactic reactions, other options such as clindamycin or macrolide antibiotics may be considered 3, 4.
- Azithromycin is an option, but there is significant resistance to azithromycin and clarithromycin in some parts of the United States 3.
- A study comparing azithromycin to penicillin V for treatment of acute group A streptococcal pharyngitis found that azithromycin had similar clinical efficacy but lower bacteriologic eradication rates 5.
- Another study found that macrolides, such as azithromycin, may have similar symptom resolution rates to penicillin, but the evidence is uncertain 6.
Alternative Antibiotic Options
- Clindamycin is an alternative option for patients allergic to penicillin and cephalosporins 4.
- Macrolide antibiotics, such as azithromycin, may be effective for treating strep throat in children, but the evidence is uncertain 6.
- Carbacephem may be more effective than penicillin for symptom resolution in adults and children, but the evidence is limited 6.