From the Guidelines
For a 9-year-old child weighing 105 pounds with strep throat, the most appropriate antibiotic treatment would be amoxicillin, 50 mg per kg once daily (maximum = 1,000 mg), for 10 days, as recommended by the IDSA guidelines 1. This recommendation is based on the strongest and most recent evidence available, which prioritizes the use of amoxicillin for the treatment of strep throat in children without penicillin allergy. The dosing is based on the child's weight, and the standard course is usually 10 days to fully eradicate the bacteria. It's essential to note that treatment decisions should be made by a qualified healthcare professional who can evaluate the child's specific condition, medical history, and allergies. The full course of antibiotics should be completed even if symptoms improve earlier to prevent complications like rheumatic fever. Additionally, parents should ensure the child gets plenty of rest, drinks fluids to stay hydrated, and may use over-the-counter pain relievers as directed by a doctor to manage throat pain and fever. If symptoms worsen or don't improve within 48 hours of starting antibiotics, medical attention should be sought. Some key points to consider when treating strep throat include:
- The importance of accurate diagnosis to prevent inappropriate administration of antimicrobials to large numbers of patients with nonstreptococcal pharyngitis 1
- The need to exclude the diagnosis of GAS pharyngitis to prevent unnecessary exposure to the expense and hazards of antimicrobial therapy 1
- The potential for streptococcal pharyngitis to lead to nonsuppurative postinfectious disorders, such as acute rheumatic fever and poststreptococcal glomerulonephritis 1
From the FDA Drug Label
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. Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy.
For a 9-year-old patient weighing 105 pounds with strep, the preferred antibiotic is penicillin by the intramuscular route, as it is the usual drug of choice for treating Streptococcus pyogenes infection and preventing rheumatic fever. Azithromycin can be considered as an alternative to first-line therapy in individuals who cannot use first-line therapy 2.
From the Research
Antibiotic Prescription for Strep Throat
For a nine-year-old weighing 105 pounds with strep throat, the following antibiotics are recommended:
- Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days 3
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 3
Considerations for Antibiotic Resistance
- There is significant resistance to azithromycin and clarithromycin in some parts of the United States, making them less ideal options 3
- A study comparing clarithromycin and azithromycin found that 10 days of clarithromycin therapy was more effective in eradicating group A streptococci than 5 days of azithromycin therapy 4
Diagnostic Methods and Treatment Guidelines
- Clinical guidelines recommend 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 3, 5
- A throat culture is recommended in children and adolescents after a negative rapid antigen test result 3
- Symptoms such as fever, tonsillar exudate, cervical lymphadenitis, and patient ages of 3 to 15 years increase clinical suspicion of strep throat 3