If severe or refractory

1. Clindamycin 8-20 mg/kg/day PO divided qid (for penicillin allergic) [B] Easy dose: 5 mg/kg/dose PO qid

Maximum: 300 mg/dose

Available in suspension of 75 mg/5 mL

2. Cefuroxime axetil (Ceftin) 20-30 mg/kg/day PO divided bid [B] Easy dose: 20 mg/kg/day = 10 mg/kg/dose PO bid Maximum: 250 mg/dose

Available in suspension of 125 mg/5 mL

3. Cefpodoxime (Vantin) 5 mg/kg/dose PO bid [B] Maximum: 200 mg/dose

Available in suspensions of 50 mg and 100 mg/5 mL

4. Amoxicillin/clavulanate (Augmentin) 20-40 mg/kg/day (as amoxicillin) PO divided tid [B] Easy dose: 30 mg/kg/day = 10 mg/kg/dose PO tid

Maximum: 500 mg per dose

Available in suspensions of 125 mg and 250 mg amoxicillin/5 mL


1. Sexual history essential to help rule out gonococcus (see Genital Tract Infections—Gonorrhea). Lab tests include latex agglutination (rapid strep test), Gram stain and/or culture.

If prepubertal, treat for group A Streptococcus only.

2. If patient exhibits signs or symptoms of severe swelling/edema (e.g., voice change, unable to swallow saliva), consider adding prednisone (40 mg PO qd * 5 days) to the antibiotic regimen.

1. Penicillin V potassium (Pen-VEE K) 250-500 mg PO tid-qid [B]

2. Erythromycin 250 mg PO qid OR 500 mg bid [B, except estolate contraindicated]

3. Erythromycin ethyl succinate (EES) 400 mg PO qid OR 30-50 mg/kg/day PO divided qid [B]

4. Azithromycin (Zithromax) 500 mg PO initial dose, then 250 mg PO qd for 4 days [B]

5. Clarithromycin (Biaxin) 250-500 mg PO bid [C]

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