- Streptococcus pyogenes (Group A Streptococcus) (~90–95% of bacterial cases)
First-line therapy
Phenoxymethylpenicillin (Penicillin V) • p.o. • 50–50 mg/kg/day • 2×/day
Max 1000 mg/day · Duration: 10 days
Enter weight on Kids to calculate doses
Cefalexin • p.o. • 50–50 mg/kg/day • 2×/day
Max 2000 mg/day · Duration: 10 days
- • Cefalexin: non-immediate (non-Type I) penicillin allergy — 50 mg/kg/day PO 2×/day (max 2 g/day), 10 days
- • Azithromycin: immediate penicillin allergy — 12 mg/kg PO once daily (max 500 mg), 5 days
- • Clarithromycin: immediate penicillin allergy — 15 mg/kg/day PO 2×/day (max 1 g/day), 10 days
- • Clindamycin: immediate penicillin allergy — 30 mg/kg/day PO 3×/day (max 1.8 g/day), 10 days
Clinical notes
- • Confirm GAS before antibiotics whenever appropriate.
- • Viral pharyngitis does not require antibiotics.
- • Antibiotics reduce the risk of acute rheumatic fever in confirmed GAS infection.
- • Clinical reassessment if symptoms persist or worsen.
- • IDSA Clinical Practice Guideline — GAS Pharyngitis (2012)
- • ESPID Guideline (2024)
- • NICE NG84 (2018)
+ 1 more
- • AAP Red Book — Group A Streptococcal Infections (2024)
