Template:Streptococcal Pharyngitis Antibiotics: Difference between revisions

(Created page with "'''Tx can be delayed for up to 9 days and still prevent major sequelae''' '''Penicillin Options:''' *Penicillin V 250mg PO BID x 10d (child) or 500mg BID x 10d (ado...")
 
(Add explicit pediatric dosing section for Streptococcal pharyngitis)
 
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'''Tx can be delayed for up to 9 days and still prevent major sequelae'''  
''Treatment can be delayed for up to 9 days and still prevent major sequelae''
 
'''[[Penicillin]] Options:'''
'''[[Penicillin]] Options:'''
*[[Penicillin V]] 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent)
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Penicillin V|dose=250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent or adult)|context=Penicillin Options}}<ref name=Shulman12>Shulman, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2012;55(10):1279–82</ref><ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>
*[[Bicillin L-A]] 25-50Kmg/kg IM x 1 (max dose = 1.2million)
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Bicillin L-A|dose=<27 kg: 0.6 million units; ≥27 kg: 1.2 million units IM x 1|context=Penicillin Options}}<ref name=Shulman12/><ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Amoxicillin|dose=50 mg/kg once daily (maximum = 1000 mg) for 10 days|context=Penicillin Options}}<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>
 
'''[[Penicillin]] allergic (mild):'''
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Cephalexin|dose=20 mg per kg PO BID (maximum 500 mg per dose) x 10 days|context=Penicillin Allergy (mild)}}<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Cefadroxil|dose=30 mg per kg PO QD (maximum 1 g daily) x 10 days|context=Penicillin Allergy (mild)}}<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>


'''[[Penicillin]] allergic (anaphylaxis):<ref name=Shulman12/>'''
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Clindamycin|dose=7 mg/kg/dose TID (maximum = 300 mg/dose) x 10 days|context=Penicillin Allergy (anaphylaxis)}}<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Azithromycin|dose=12 mg/kg PO once (maximum = 500 mg), then 6 mg/kg (max=250 mg) once daily for the next 4 days|context=Penicillin Allergy (anaphylaxis)}}<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Clarithromycin|dose=7.5 mg/kg/dose PO BID (maximum = 250 mg/dose) x 10 days|context=Penicillin Allergy (anaphylaxis)}}<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>


'''[[Penicillin]] allergic (mild):'''
*[[Cefuroxime]] 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d


'''Pediatric Dosing:'''
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Amoxicillin|dose=50mg/kg PO once daily x 10 days (max 1000mg)|context=Pediatric First Line|population=Pediatric}}
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Penicillin V|dose=<27kg: 250mg PO BID-TID x 10 days; >27kg: 500mg PO BID-TID x 10 days|context=Pediatric First Line|population=Pediatric}}
*{{AntibioticDose|disease=Streptococcal pharyngitis|drug=Penicillin G Benzathine|dose=<27kg: 600,000 units IM x 1; >27kg: 1.2 million units IM x 1|context=Pediatric First Line|population=Pediatric}}
*PCN allergy (mild): {{AntibioticDose|disease=Streptococcal pharyngitis|drug=Cephalexin|dose=20mg/kg PO BID x 10 days (max 500mg/dose)|context=Pediatric PCN Allergy|population=Pediatric}}
*PCN allergy (mild): {{AntibioticDose|disease=Streptococcal pharyngitis|drug=Cefadroxil|dose=30mg/kg PO daily x 10 days (max 1g)|context=Pediatric PCN Allergy|population=Pediatric}}
*PCN allergy (severe): {{AntibioticDose|disease=Streptococcal pharyngitis|drug=Azithromycin|dose=12mg/kg PO day 1 (max 500mg), then 6mg/kg daily x 4 days (max 250mg)|context=Pediatric PCN Allergy (severe)|population=Pediatric}}
*PCN allergy (severe): {{AntibioticDose|disease=Streptococcal pharyngitis|drug=Clindamycin|dose=7mg/kg/dose PO TID x 10 days (max 300mg/dose)|context=Pediatric PCN Allergy (severe)|population=Pediatric}}
*PCN allergy (severe): {{AntibioticDose|disease=Streptococcal pharyngitis|drug=Clarithromycin|dose=7.5mg/kg PO BID x 10 days (max 250mg/dose)|context=Pediatric PCN Allergy (severe)|population=Pediatric}}


'''[[Penicillin]] allergic (anaphylaxis):'''
*{{AntibioticDose|drug=Clindamycin|dose=7mg/kg/dose PO q8h x 10 days<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>; Max: 300mg/dose|context=Streptococcal Pharyngitis|disease=Pharyngitis|population=Pediatric}}
*[[Clindamycin]] 7.5mg/kg PO QID x 10d (child) or 450mg PO TID x 10d OR
*{{AntibioticDose|drug=Azithromycin|dose=Children ≥2 years and Adolescents: Oral: 12mg/kg/dose once daily for 5 days (maximum: 500mg daily)|context=Pharyngitis (as an alternative agent in penicillin allergic patients)|disease=Pharyngitis|population=Pediatric}}
*[[Azithromycin]] 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5
*{{AntibioticDose|drug=Amoxicillin|dose=50mg/kg PO q24h x 10 days<ref>CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html</ref>; Max: 1000mg/day|context=Strep Pharyngitis|disease=Pharyngitis|population=Pediatric}}
*{{AntibioticDose|drug=Clarithromycin|dose=>6mo: 15mg/kg/day PO divided q12h x 7-10d|context=Pharyngitis/tonsillitis, streptococcal|disease=Pharyngitis|population=Pediatric}}
*{{AntibioticDose|drug=Cephalexin|dose=40mg/kg/day PO divided q12h x 10 days; Max: 500mg/dose|context=Streptococcal Pharyngitis (>1 Year)|disease=Pharyngitis|population=Pediatric}}
*{{AntibioticDose|drug=Cefpodoxime|dose=100mg q 12 h for 5-10 days|context=Pharyngitis/Tonsillitis|disease=Pharyngitis|population=Adult}}
*{{AntibioticDose|drug=Cefuroxime|dose=250mg PO bid x10 days|context=Pharyngitis/Tonsillitis, streptococcal|disease=Pharyngitis|population=Adult}}
*{{AntibioticDose|drug=Cefuroxime|dose=250mg PO bid x10 days|context=12+ yo, Pharyngitis/Tonsillitis, streptococcal|disease=Pharyngitis|population=Pediatric}}

Latest revision as of 12:56, 20 March 2026

Treatment can be delayed for up to 9 days and still prevent major sequelae

Penicillin Options:

Penicillin allergic (mild):

  • Cephalexin 20 mg per kg PO BID (maximum 500 mg per dose) x 10 days[5]
  • Cefadroxil 30 mg per kg PO QD (maximum 1 g daily) x 10 days[6]

Penicillin allergic (anaphylaxis):[1]

  • Clindamycin 7 mg/kg/dose TID (maximum = 300 mg/dose) x 10 days[7]
  • Azithromycin 12 mg/kg PO once (maximum = 500 mg), then 6 mg/kg (max=250 mg) once daily for the next 4 days[8]
  • Clarithromycin 7.5 mg/kg/dose PO BID (maximum = 250 mg/dose) x 10 days[9]


Pediatric Dosing:

  • Amoxicillin 50mg/kg PO once daily x 10 days (max 1000mg)
  • Penicillin V <27kg: 250mg PO BID-TID x 10 days; >27kg: 500mg PO BID-TID x 10 days
  • Penicillin G Benzathine <27kg: 600,000 units IM x 1; >27kg: 1.2 million units IM x 1
  • PCN allergy (mild): Cephalexin 20mg/kg PO BID x 10 days (max 500mg/dose)
  • PCN allergy (mild): Cefadroxil 30mg/kg PO daily x 10 days (max 1g)
  • PCN allergy (severe): Azithromycin 12mg/kg PO day 1 (max 500mg), then 6mg/kg daily x 4 days (max 250mg)
  • PCN allergy (severe): Clindamycin 7mg/kg/dose PO TID x 10 days (max 300mg/dose)
  • PCN allergy (severe): Clarithromycin 7.5mg/kg PO BID x 10 days (max 250mg/dose)
  1. ↑ 1.0 1.1 1.2 Shulman, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2012;55(10):1279–82
  2. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  3. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  4. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  5. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  6. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  7. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  8. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  9. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  10. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  11. ↑ CDC Website, accessed 2026-28-01. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
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