From the Guidelines
For strep pharyngitis in a 2-year-old, the recommended treatment is amoxicillin 50 mg/kg/day divided into two doses for 10 days (maximum 1000 mg/day) 1. This recommendation is based on the strongest and most recent evidence from the Infectious Diseases Society of America guidelines. The guidelines emphasize the importance of accurate diagnosis and appropriate antimicrobial therapy to prevent complications such as acute rheumatic fever and suppurative complications. Key points to consider in the treatment of strep pharyngitis in a 2-year-old include:
- Completing the full course of antibiotics even if symptoms improve quickly
- Staying home from daycare or school until at least 24 hours of antibiotics have been taken and the child is fever-free
- Using supportive care such as acetaminophen or ibuprofen for pain and fever, encouraging fluid intake, and offering soft foods if swallowing is painful
- Diagnosing strep throat through rapid antigen detection tests or throat cultures, as clinical symptoms alone are not reliable in young children If the child has a penicillin allergy, alternatives include cephalexin 20 mg/kg/dose twice daily (maximum 500 mg/dose) for 10 days 1, or in cases of severe penicillin allergy, azithromycin 12 mg/kg once daily for 5 days (maximum 500 mg/day) 1. It's crucial to note that the choice of antibiotic should be based on the severity of the allergy and the potential for resistance. The American Heart Association also recommends the use of penicillin or amoxicillin as the first-line treatment for strep pharyngitis, with alternatives such as cephalexin or azithromycin for patients with penicillin allergy 1. Overall, the goal of treatment is to prevent complications, reduce symptoms, and minimize the risk of transmission to others.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. Safety and effectiveness in the treatment of pediatric patients with pharyngitis/tonsillitis under 2 years of age have not been established.
Azithromycin is not recommended for the treatment of strep pharyngitis in a 2-year-old patient, as safety and effectiveness have not been established in patients under 2 years of age 2, 2.
From the Research
Diagnosis of Strep Pharyngitis in a 2-Year-Old
- Strep pharyngitis, caused by Group A beta-hemolytic streptococcus (GABHS), is a common bacterial infection in children 3, 4, 5, 6.
- The diagnosis of strep pharyngitis usually cannot be reliably distinguished from other etiologies on the basis of epidemiologic or physical findings, and therefore a throat culture or a rapid antigen detection test is generally necessary to confirm the diagnosis 3.
- Clinical decision rules, such as the presence of fever, tonsillar exudate, cervical lymphadenitis, and patient ages of 3 to 15 years, can increase clinical suspicion of strep pharyngitis 5.
Treatment of Strep Pharyngitis in a 2-Year-Old
- Antibiotic treatment is recommended for strep pharyngitis to prevent acute rheumatic fever and suppurative complications, hasten resolution of clinical signs and symptoms, and prevent transmission to close contacts 3, 4, 5, 6.
- The recommended first-line therapy for strep pharyngitis is a 10-day course of penicillin V, usually given 2 or 3 times per day 3.
- Alternative antibiotics, such as amoxicillin, cephalosporins, and macrolides, can be used in patients who are allergic to penicillin or have other contraindications 3, 5, 7.
- A 5-day dosing schedule of certain cephalosporins, such as cefdinir, may be an alternative to the traditional 10-day course of penicillin V, potentially increasing adherence to treatment 3.
Considerations for Young Children
- Strep pharyngitis is rare in children under 3 years of age, and becomes more common in school-aged children with a peak at 7-8 years of age 4.
- The treatment of strep pharyngitis in young children should take into account the potential for antibiotic resistance and the importance of adherence to the full course of therapy 3, 7.
- Palatability of antibiotics is an important consideration when prescribing to children, with some cephalosporins having a more pleasant taste than other antibiotics 3.