Pharyngitis is one of the most common
infectious diseases affecting children. Group A streptococci are the leading bacterial cause of
pharyngitis in children and adults. Because inappropriate
antibiotic treatment for
pharyngitis is becoming a major issue, only true group A beta-hemolytic streptococcus (GABHS)
infections, proven by rapid
antigen test or culture, should be treated with
antibiotics. GABHS
pharyngitis is often a mild and self-limiting
infection in the absence of antimicrobial
therapy. However, antimicrobial treatment must be administered to eradicate the pathogen from the throat, limit the spread of the
infection and prevent possible progression to
rheumatic fever, suppurative disease or toxin-mediated complications.
Penicillin V for 10 days is the standard
therapy and is effective in the management of GABHS
pharyngitis. However, there are drawbacks to
penicillin V therapy, including the length of the dosing regimen, which are leading to decreasing
penicillin prescription rates in many countries. In addition bacteriologic treatment failures have been documented in up to 35% of GABHS patients treated with
penicillin V, particularly in children <6 years old. A number of mechanisms may be responsible for these failures, but poor compliance with the standard 10-day
penicillin treatment is likely to be a major factor. There is growing evidence to suggest that children with GABHS
pharyngitis can be effectively treated with non-
penicillin V antibiotics, which have the advantage of simpler and shorter dosing regimens compared with
penicillin V. Among the
antibiotics that have been tested clinically,
azithromycin is the most widely studied. A total dose of 60 mg/kg
azithromycin, given either as 12 mg/kg once daily for 5 days or 20 mg/kg once daily for 3 days, provides the best rate of GABHS eradication. Thus a total dose of 60 mg/kg
azithromycin given during 3 or 5 days constitutes an alternative treatment to standard
penicillin therapy in cases of
penicillin hypersensitivity, when patient nonadherence to a 10-day
penicillin regimen is suspected or for patients who fail
therapy with a
beta-lactam.