Streptococcal Pharyngitis

Patient Population: Pediatric
Condition Major Pathogens  First Choice Therapy Alternative Therapy Comments
Streptococcal pharyngitis  Group A streptococcus 

50 mg/kg/dose (max 1000 mg/dose) enterally daily  


Anticipated difficulty tolerating or adhering to enteral therapy

Weight < 27 kg: Benzathine Penicillin G 600,000 units IM x 1 dose 

Weight > 27 kg: Benzathine Penicillin G 1.2 million units IM x 1 dose 

Penicillin allergy with lower risk for allergic reaction

25 mg/kg/dose (max 500 mg/dose) enterally bid  


Penicillin allergy with higher risk for allergic reaction

7 mg/kg/dose (max 300 mg/dose) enterally tid 

Azithromycin is not recommended for this indication.  

Duration for oral beta lactam therapy (not Benzathine Penicillin): 10 days 

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.