If severe or refractory

1. Amoxicillin/clavulanate (Augmentin) 500 mg PO tid or 875 mg PO bid [B]

2. Cefuroxime axetil (Ceftin) 500 mg PO bid [B]

3. Cefpodoxime (Vantin) 200 mg PO bid [B]

4. Cefprozil (Cefzil) 250 mg PO bid [B] OR (if severe penicillin allergy or suspect DRSP)

5. Levofloxacin (Levaquin) 500 mg Po qd (if severe penicillin allergy or suspect DRSP; [C])

Course: 7 to 21 days (except azithromycin as noted)

Organisms: S. pneumoniae, H. influenzae, group A Streptococcus, M. catarrhalis, anaerobes Tonsillitis/Pharyngitis

A. CHILDREN AGE 10 AND UNDER

Note: If patient exhibits signs or symptoms of severe swelling/edema (e.g., voice change, unable to swallow saliva), consider adding prednisone (1-2 mg/kg PO * 5 days) to the antibiotic regimen.

1. Penicillin V potassium (Pen VEE-K) 25-50 mg/kg/day PO divided tid-qid [B] Easy dose: 45 mg/kg/day = 15 mg/kg/dose PO tid

Maximum: 500 mg/dose

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

2. Amoxicillin (Amoxil) 20-50 mg/kg/day PO divided tid [B] Easy dose: 30 mg/kg/day = 10 mg/kg/dose PO tid

Maximum: 250 mg/dose

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

3. Erythromycin ethyl succinate (EES) 30-50 mg/kg/day PO divided qid [B] Easy dose: 40 mg/kg/day = 10 mg/kg/dose PO qid

Maximum: 500 mg/dose

Available in suspensions of 200 mg and 400 mg/5 mL

4. Azithromycin (Zithromax) 10 mg/kg PO initial dose, then 5 mg/kg/day for 4 days [B] Maximum: 500 mg day 1 and 250 mg days 2-5

Available in suspensions of 100 mg and 200 mg/5 mL

5. Benzathine penicillin G (Bicillin L-A)—single dose therapy [B] In children less than 60 lb: 600,000 units IM

In children greater than 60 lb: 1.2 million units IM

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