From the Guidelines
Streptococcus infections in children, particularly strep throat, should be treated with antibiotics when confirmed through testing, with the first-line treatment being penicillin, specifically amoxicillin at 50 mg/kg/day (maximum 1000 mg daily) divided into two doses for 10 days, as recommended by the Infectious Diseases Society of America 1. The diagnosis of streptococcal pharyngitis should be established through testing, and antimicrobial therapy should be initiated promptly to prevent complications like rheumatic fever, kidney inflammation, or abscess formation. For children with penicillin allergies, alternatives include azithromycin (12 mg/kg once daily for 5 days, maximum 500 mg) or clindamycin (7 mg/kg three times daily for 10 days) 1. It's essential to complete the full course of antibiotics even if symptoms improve quickly. Children should stay home from school or daycare until they've been on antibiotics for at least 24 hours and are fever-free. Supportive care includes:
- Adequate hydration
- Acetaminophen or ibuprofen for pain and fever
- Salt water gargles for older children Prompt treatment is crucial to prevent complications, and if symptoms worsen despite antibiotics or if the child develops a rash, difficulty breathing, or persistent fever, immediate medical attention should be sought 1. Most children recover completely within a week with appropriate treatment. The American Heart Association also recommends a 4-week regimen of intravenous aqueous crystalline penicillin G for the treatment of infective endocarditis caused by streptococci 1. However, for the treatment of streptococcal pharyngitis, the guidelines from the Infectious Diseases Society of America should be followed 1.
From the FDA Drug Label
Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae. Infections of the Genitourinary Tract: Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Escherichia coli, Proteus mirabilis, or Enterococcus faecalis Infections of the Skin and Skin Structure:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspp. (α-and β-hemolytic isolates only), Staphylococcusspp., or E. coli. Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained
For Streptococcus management in kids,
- Amoxicillin can be used to treat infections due to susceptible Streptococcus species.
- The treatment should be continued for a minimum of 48 to 72 hours beyond the time the patient becomes asymptomatic or evidence of bacterial eradication has been obtained 2.
In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur. Cultures should be taken following completion of treatment to determine whether streptococci have been eradicated.
- Penicillin can also be used to treat streptococcal infections, with a minimum treatment duration of 10 days to eliminate the organism 3.
From the Research
Streptococcus Management for Kids
- The most common bacterial cause of acute pharyngitis in children is Group A beta-hemolytic streptococcus (GABHS) 4.
- Treatment with antibiotics is recommended to prevent acute rheumatic fever, suppurative complications, and transmission to close contacts 4.
- A throat culture or rapid antigen detection test is necessary to confirm the diagnosis of streptococcal pharyngitis 4.
Antibiotic Treatment Options
- Penicillin V is the recommended first-line therapy for streptococcal pharyngitis, given for 10 days 4.
- Alternative antibiotics include other penicillins, macrolides, and cephalosporins 4.
- Cephalosporins may provide higher bacteriologic eradication rates than penicillin V 4.
- Short-duration antibiotics (3-6 days) may have comparable efficacy to standard 10-day treatment 5.
Clinical Presentation and Management
- Invasive group A streptococcal disease (iGAS) can have varied clinical presentations in children, including pneumonia and empyema 6.
- Early diagnosis and prompt initiation of appropriate antibiotics can help resolve symptoms and improve outcomes 6.
- The incidence of iGAS infections has increased in recent years, highlighting the need for renewed focus on diagnosis, management, and prevention 6.
Comparative Efficacy of Antibiotics
- There is uncertainty regarding the comparative efficacy of different antibiotics in treating streptococcal pharyngitis 7.
- Cephalosporins may be more effective than penicillin in resolving symptoms, but the evidence is low-certainty 7.
- Macrolides and penicillin may have similar efficacy in resolving symptoms, but the evidence is also low-certainty 7.
Treatment in Young Children
- Streptococcal tonsillitis/pharyngitis is common in children, and antibiotic treatment can eliminate the risk of subsequent rheumatic fever 8.
- GAS pharyngitis peaks in late winter and early spring months, and colonization is higher in winter months 8.
- Pharyngitis caused by GAS is rare in children under 3 years of age and becomes less common in late adolescence through adulthood 8.