Pediatric Guidelines: Respiratory Infections - Streptococcal Pharyngitis

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Streptococcal pharyngitis Group A streptococcus

Able to take tablets:

<=27 kg: Penicillin VK 250mg/dose PO BID

> 27 kg: Penicillin VK 500mg/dose PO BID

Non-severe penicillin allergy:

Cephalexin 25mg/kg/dose PO BID (max 500mg/dose)

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

Unable to take tablets:

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

Severe penicillin allergy:

Azithromycin 12mg/kg/dose PO daily x 5 days (max 500mg/dose)

Unable to tolerate oral therapy or adherence of concern:

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

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


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 PediatricsCirculation 2009;119:1541-1551.

Shulman, ST, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of AmericaClin Infect Dis 2012;55:e86-e102.

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. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).