Streptococcal Pharyngitis

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

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

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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: 

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

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Penicillin allergy with higher risk for allergic reaction: 

Clindamycin  
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 

References: 

Gerber, MA, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 2009;119:1541-1551.  

American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.  

Respiratory, Head, and Neck Infections