Tonsillitis and Pharyngitis Empiric Therapy 

Updated: Nov 12, 2018
Author: Udayan K Shah, MD, FACS, FAAP; Chief Editor: Michael Stuart Bronze, MD 

Empiric Therapy Regimens

Empiric therapeutic regimens for tonsillitis and pharyngitis are outlined below, including adult and pediatric dosages for both penicillin-allergic and non-penicillin-allergic patients.[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]

If results are not available for rapid strep test, culture, or Monospot

Adult dosage:

  • Penicillin V 500 mg PO BID for 10d or 250 mg PO QID for 10d or

  • Benzathine penicillin G 1.2 million U IM once or

  • Amoxicillin 500-875 mg PO q12h or 250-500 mg PO q8h for 10d or

  • Cefdinir 600 mg PO once daily for 10d or 300 mg PO q12h for 5-10d or

  • Cefuroxime axetil 250 mg PO once daily for 4d

Pediatric dosage:

  • Penicillin V 25-50 mg/kg/day divided q6h for 10d or

  • Benzathine penicillin G 25,000 U/kg IM once (maximum 1.2 million U) or

  • Amoxicillin 50 mg/kg/day PO in 2 or 3 divided doses for 10d or

  • Amoxicillin-clavulanate 500-875 mg PO q12h for 10d

  • Cefdinir 14 mg/kg PO once daily for 10d or

  • Cefuroxime axetil 10 mg/kg PO BID for 4-10d

Adult dosage if penicillin allergic:

  • Azithromycin 500 mg PO daily for 5d or

  • Clarithromycin 250 mg PO q12h for 10d or

  • Erythromycin base 500 mg PO QID for 10d or

  • Clindamycin 7 mg/kg/day in 3 divided doses (maximum 1.8 g/d) for 10d

  • Levofloxacin 500 mg PO once daily for 7d

Pediatric dosage if penicillin allergic:

  • Azithromycin 12 mg/kg PO once daily for 5d or

  • Clarithromycin 250 mg PO q12h for 10d or

  • Erythromycin succinate 20 mg/kg PO BID for 10d or

  • Clindamycin 7 mg/kg/day PO in 3 divided doses (maximum 1.8 g/d) for 10d