Early relapse

(2-7 days post-therapy)

 

- Ensure that picture still fits best with Group A Strep versus viral pharyngitis. Swab again and wait for results before retreating. 

- Group A Strep resistance to macrolides and clindamycin is significant but none are resistant to penicillin.

 

Empiric Therapy

Dose

Duration
If can take tablets:    
Penicillin VK ≤ 27kg: 300 mg per dose PO 2 or 3 times per day

10 days

  > 27kg: 600 mg per dose PO 2 or 3 times per day  
If suspension required:    
Amoxicillin 50mg/kg PO once daily (or 25mg/kg 2 times per day) (maximum 1000mg per day)

10 days

Penicillin allergy

Empiric Therapy

Dose

Duration

Cephalexin

40mg/kg/d PO div bid 10 days

Penicillin and cephalexin allergy

Empiric Therapy Dose Duration
Azithromycin

12mg/kg (max. 500mg) PO daily

or

5 days

 

20mg/kg PO daily

3 days

or    
Clarithromycin 15mg/kg/d (max. 250mg per dose) PO div bid 10 days
or    
Clindamycin 20mg/kg/d PO div tid 10 days