From the FDA Drug Label
In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur.
The first line treatment for strep G in an 8-year-old is penicillin (PO) for a minimum of 10 days to eliminate the organism and prevent sequelae of streptococcal disease 1.
From the Research
The first-line treatment for Group A Streptococcal (GAS) pharyngitis in an 8-year-old child is oral penicillin V (phenoxymethylpenicillin) or amoxicillin, as recommended by the most recent and highest quality study 2. The recommended dosage for penicillin V is 250 mg taken twice daily or three times daily for 10 days. Alternatively, amoxicillin can be used at a dose of 50 mg/kg once daily (maximum 1000 mg) for 10 days, which some children may find more palatable due to better taste. Some key points to consider when treating GAS pharyngitis include:
- Completing the full 10-day course of antibiotics even if symptoms improve earlier to ensure complete eradication of the bacteria and prevent complications like rheumatic fever or post-streptococcal glomerulonephritis 3, 2.
- Using alternatives such as clindamycin (7 mg/kg three times daily for 10 days, maximum 300 mg per dose) or a first-generation cephalosporin for children with penicillin allergy 3, 2.
- Providing supportive care with adequate hydration, acetaminophen or ibuprofen for pain and fever, and salt water gargles to manage symptoms while the antibiotics take effect 3, 2. It's worth noting that Group A Streptococcus has never developed resistance to penicillin, and it has a narrow spectrum of activity which reduces the risk of antimicrobial resistance 3, 2. Additionally, a study from 2024 2 highlights the importance of using clinical decision rules to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics. Another study from 2021 4 discusses the benefits of antibiotics in treating GAS pharyngitis, including the elimination of the risk of subsequent rheumatic fever. However, the most recent and highest quality study 2 should be prioritized when making treatment decisions.