Non-responders (after 72 hours of therapy) or Early relapse (2-7 days post therapy)

Group A Streptococci resistance to macrolides and clindamycin is significant.

 
Usual Pathogens

Group A Streptococci

Non-responders

Change in antibiotic therapy may not be required.

Early relapse

Empiric Therapy Dose Duration
Amoxicillin-clavulanate 875mg PO bid 10 days

Alternative

Empiric Therapy Dose Duration
Azithromycin 500mg PO daily 3 days
or    
Clarithromycin 250mg PO bid 10 days
or    
Clindamycin 300mg PO tid 10 days