What is the management of Streptococcal (Streptococcus) infections in pediatric patients?

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 oral penicillin V or amoxicillin for 10 days, as recommended by the Infectious Diseases Society of America 1. The treatment of streptococcal pharyngitis in children is crucial to prevent complications such as acute rheumatic fever and to reduce the transmission of the bacteria to others.

• The dosage of penicillin V is 250mg twice daily for children under 12 and 500mg twice daily for older children, given for 10 days.
• Alternatively, amoxicillin can be used at 50mg/kg/day divided into two doses (maximum 1000mg daily) for 10 days.
• For penicillin-allergic patients, azithromycin (12mg/kg once daily, maximum 500mg) for 5 days or clindamycin (7mg/kg three times daily, maximum 300mg per dose) for 10 days are appropriate options, as stated in the 2012 update by the Infectious Diseases Society of America 1. It is essential to complete the full antibiotic course even if symptoms improve quickly to prevent complications like rheumatic fever, as treatment within 9 days of the onset of illness is effective in preventing acute rheumatic fever (ARF) 1. Children should stay home from school for 24 hours after starting antibiotics, and supportive care includes adequate hydration, acetaminophen or ibuprofen for pain and fever, and salt water gargles for older children. Antibiotics are important because they reduce symptom duration, prevent complications, and decrease transmission to others by eliminating the bacteria from the throat within 24 hours of treatment initiation, as supported by the evidence from the Infectious Diseases Society of America 1.

From the FDA Drug Label

Pediatric Patients: ... Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. 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 In streptococcal infections, therapy must be sufficient to eliminate the organism (ten-day minimum): otherwise the sequelae of streptococcal disease may occur.

Streptococcus management for kids:

• The first-line therapy for Streptococcus pyogenes infection is penicillin by the intramuscular route.
• Azithromycin can be used as an alternative to first-line therapy in individuals who cannot use first-line therapy.
• The treatment should be sufficient to eliminate the organism, with a minimum of 10 days of therapy.
• Susceptibility tests should be performed to determine the causative organism and its susceptibility to the chosen antibiotic 2.

From the Research

Streptococcus Management for Kids

• The management of streptococcal infections in children involves the use of antibiotics, with erythromycin being a highly effective treatment option for both streptococcal pharyngitis and skin infections 3.
• The appropriate daily dosage for erythromycin estolate is 20 to 30 mg/kg/day, while that for erythromycin ethylsuccinate is 40 mg/kg/day 3.
• Treatment of streptococcal pharyngitis should be for 10 days, and recent studies have shown erythromycin to be superior to penicillin in the treatment of streptococcal skin infections 3.

Diagnosis and Treatment

• The diagnosis of group A streptococcal (GAS) pharyngitis in children can be made using a 'rapid antigen detection test' (RADT) and/or a throat culture 4.
• Antibiotic treatment of GAS pharyngitis is indicated to eliminate the presence of bacteria from the pharynx and remove the risk of subsequent rheumatic fever 5.
• Amoxicillin or penicillin are recommended treatment options for children with GAS pharyngitis, with the treatment duration being 10 days 6.

Clinical Presentations and Management

• Invasive group A streptococcal disease (iGAS) can have varied clinical presentations in children, including pneumonia with or without empyema, and can be responsible for prolonged hospital stays and mortality 7.
• Early diagnosis and prompt initiation of appropriate antibiotics, such as IV benzylpenicillin, can help in the resolution of symptoms and good outcomes in children with iGAS 7.
• The incidence of iGAS infections has increased over the last decade, highlighting the need for renewed focus on early diagnosis, management, and prevention of this disease 7.