What is the appropriate Kenalog (triamcinolone acetonide) dose for a 240‑pound adult man with streptococcal pharyngitis?

Kenalog (Triamcinolone) Should NOT Be Used for Strep Throat

Corticosteroids, including Kenalog (triamcinolone acetonide), are explicitly NOT recommended as adjunctive therapy for streptococcal pharyngitis and have no role in the treatment of strep throat. 1, 2

Why Corticosteroids Are Contraindicated

• The Infectious Diseases Society of America explicitly advises against the use of corticosteroids as adjunctive therapy for Group A streptococcal pharyngitis because they do not prevent acute rheumatic fever or suppurative complications such as peritonsillar abscess. 1, 2

• The primary treatment goals for strep throat are bacterial eradication to prevent acute rheumatic fever and suppurative complications—outcomes that corticosteroids cannot achieve. 1, 2

• Corticosteroids provide only symptomatic relief without addressing the underlying infection or preventing serious complications. 2

Appropriate Treatment for a 240-Pound Adult Man

First-Line Antibiotic Therapy

For a 240-pound (109 kg) adult man with confirmed streptococcal pharyngitis, prescribe penicillin V 500 mg orally twice daily for 10 days OR amoxicillin 500 mg orally twice daily for 10 days. 1, 3, 4

• Penicillin and amoxicillin remain the drugs of choice due to proven efficacy, zero documented resistance worldwide, narrow antimicrobial spectrum, excellent safety profile, and low cost. 1, 2, 3

• A full 10-day course is mandatory to achieve maximal pharyngeal eradication and prevent acute rheumatic fever, even if symptoms resolve within 3–4 days. 1, 2, 3, 4

Alternatives for Penicillin Allergy

Non-immediate (delayed) penicillin allergy:

• Cephalexin 500 mg orally twice daily for 10 days (cross-reactivity risk only 0.1%). 2, 3

Immediate/anaphylactic penicillin allergy:

• Clindamycin 300 mg orally three times daily for 10 days (preferred; ~1% resistance rate in the US). 1, 2, 3
• Azithromycin 500 mg once daily for 5 days (acceptable alternative; 5–8% macrolide resistance). 1, 2

Symptomatic Relief (NOT Corticosteroids)

• Offer acetaminophen or NSAIDs (ibuprofen) for moderate-to-severe sore throat, fever, or systemic discomfort. 1, 2
• These analgesics provide effective pain and fever control without the risks associated with corticosteroids. 2

Critical Pitfalls to Avoid

• Do NOT prescribe Kenalog or any corticosteroid for strep throat—they do not prevent complications and are explicitly contraindicated by guidelines. 1, 2
• Do NOT shorten the antibiotic course below 10 days (except azithromycin's 5-day regimen), as this markedly increases treatment failure and rheumatic fever risk. 1, 2, 3
• Do NOT use cephalosporins in patients with immediate/anaphylactic penicillin reactions due to ~10% cross-reactivity risk. 1, 2