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 | Duration | |
|---|---|---|
| If can take tablets: | ||
| Penicillin VK | ≤ 27kg: 300 mg per dose PO 2 or 3 times per day | |
| > 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) |
Penicillin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| 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 |