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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Treatment of pharyngitis due to group A Streptococcus in children and adolescents

Treatment of pharyngitis due to group A Streptococcus in children and adolescents
Antibiotic class Drug Dosing in children and adolescents* Advantages Disadvantages
Penicillins
(preferred)		 Penicillin V
  • If ≤27 kg: 250 mg 2 to 3 times daily for 10 days
  • If >27 kg: 500 mg 2 to 3 times daily for 10 days
  • Narrow spectrum
  • No documented resistance
  • Low cost
  • Thrice-daily dosing; however, twice-daily regimen appears to be as effective as thrice daily[1]
Amoxicillin*
  • 50 mg/kg per day orally (maximum 1000 mg per day) for 10 days
  • May be administered once daily or in 2 equally divided doses
  • Taste of suspension more palatable than penicillin, often preferred for children
  
Penicillin G benzathine
(Bicillin L-A)
  • If ≤27 kg: Penicillin G benzathine (Bicillin L-A) 600,000 units IM as a single dose
  • If >27 kg: Penicillin G benzathine (Bicillin L-A) 1.2 million units IM as a single dose
  • Can be given as a single dose
  • Ensured adherence
  • Only drug studied for prevention of acute rheumatic fever
  • Variable availability
  • High cost
  • Injection site pain
Cephalosporins
(potential alternatives for mild reactions to penicillinΔ)		 Cephalexin*
(first generation)
  • 40 mg/kg/day divided twice daily for 10 days (maximum 500 mg/dose)
  • High efficacy rate
  • Narrower spectrum than later-generation cephalosporins
  • Broader spectrum than penicillin
  • Greater potential to induce antibiotic resistance
Cefuroxime*
(second generation)
  • 10 mg/kg/dose orally twice daily for 10 days (maximum 250 mg/dose)
  • High efficacy rate
  • Narrower spectrum than later-generation cephalosporins
  • Broader spectrum than penicillin and first-generation cephalosporins
  • Greater potential to induce antibiotic resistance
Cefpodoxime*
(third generation)
  • 5 mg/kg/dose orally every 12 hours (maximum 100 mg/dose) for 5 to 10 days
  • High efficacy rate
  • FDA approved for 5-day course
  • Broader spectrum than penicillin and earlier-generation cephalosporins
  • Greater potential to induce antibiotic resistance
Cefdinir*
(third generation)
  • 7 mg/kg/dose orally every 12 hours for 5 to 10 days or 14 mg/kg/dose every 24 hours for 10 days (maximum 600 mg/day)
  • High efficacy rate
  • FDA approved for 5-day course when dosed twice daily
  • Broader spectrum than penicillin and earlier-generation cephalosporins
  • Greater potential to induce antibiotic resistance
Macrolides
(alternatives for patients with anaphylaxis or other IgE-mediated reactions or severe delayed reactions to penicillinΔ)		 Azithromycin
  • 12 mg/kg/day (maximum 500 mg/dose) for 5 days
  • Can be given as a 5-day course due to extended half-life
  • Growing rates of resistance
  • Associated with QTc prolongation and, rarely, life-threatening cardiovascular events including TdP; assess risk (eg, history of long QT interval, interacting medications, electrolyte abnormalities)
Clarithromycin*
  • 7.5 mg/kg/dose (maximum 250 mg per dose) orally twice daily for 10 days
  
  • Growing rates of resistance
  • Greater gastrointestinal side effects than azithromycin
  • Causes CYP3A4 drug interactions
  • QTc interval prolongation: Refer to azithromycin
Lincosamides
(alternative when macrolide resistance is a concern and penicillins and cephalosporins cannot be used)		 Clindamycin
  • 7 mg/kg/dose (maximum 300 mg per dose) orally 3 times daily for 10 days
  
  • Growing rates of resistance
  • High side effect profile (ie, gastrointestinal)

IM: intramuscularly; FDA: US Food and Drug Administration; TdP: torsades de pointes.

* Dose alteration may be needed for renal insufficiency.

¶ In children weighing ≤27 kg, the combination IM formulation of 900,000 units benzathine penicillin G with 300,000 units procaine penicillin G (Bicillin C-R 900/300) is a less painful alternative. Efficacy in larger children and adults has not been established.

Δ Approach to patients with penicillin allergy varies among experts and allergy severity; refer to UpToDate text for additional details.
Reference:
  1. Lan AJ, Colford JM, Colford JM Jr; The impact of dosing frequency on the efficacy of 10-day penicillin or amoxicillin therapy for streptococcal tonsillopharyngitis: A meta-analysis. Pediatrics; 2000 Feb; 105:E19.

Data from:

  1. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of Group A Streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:e86.
  2. Gerber MA, Baltimore RS, Eaton CB, 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.
  3. American Academy of Pediatrics. Group A Streptococcal Infections. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawuer MH (Eds), American Academy of Pediatrics 2015. p.694.
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