Specific Organisms and Therapeutic Regimens
Organism-specific therapeutic regimens for tonsillitis and pharyngitis are provided below, including those for Streptococcus pyogenes; groups B, C, and G β-hemolytic streptococci; Fusobacterium necrophorum; Arcanobacterium haemolyticum; and Neisseria gonorrhoeae. [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16]
Streptococcus pyogenes (group A beta-hemolytic streptococcus)
Adult dosage:
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Penicillin V 500 mg PO BID for 10d or
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Benzathine penicillin G 1.2 million U IM once or
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Amoxicillin 500-875 mg PO q12h or 250-500 PO q8h for 10d or
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Cephalexin 500 mg PO BID for 10d or
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Cefdinir 600 mg PO once daily for 10d or
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Cefprozil 500 mg PO once daily for 10d
Pediatric dosage:
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Penicillin V 25-50 mg/kg/day divided q6h for 10d or
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Benzathine penicillin G 25,000 U/kg IM once (maximum 1.2 million U) or
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Amoxicillin 50 mg/kg/day PO in 2 or 3 divided doses for 10d or
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Amoxicillin-clavulanate 500-875 mg PO q12h for 10d or
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Cefuroxime axetil 20 mg/kg/day in 2 divided doses for 4-10d or
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Cefdinir 14 mg/kg q24h for 10d or
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Cefprozil 15 mg/kg/day in 2 divided doses for 10d
Adult dosage if penicillin allergic:
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Azithromycin 500 mg PO daily for 5d or
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Clarithromycin 250 mg PO q12h for 10d or
-
Clindamycin 7 mg/kg/day in 3 divided doses (maximum 1.8 g/day) for 10d
Pediatric dosage if penicillin allergic:
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Azithromycin 12 mg/kg PO once daily for 5d or
-
Clarithromycin 250 mg PO q12h for 10d or
-
Clindamycin 7 mg/kg/day PO in 3 divided doses (maximum 1.8 g/day) for 10d
Group B, C and G beta-hemolytic streptococci
Adult dosage:
-
Penicillin V 500 mg PO BID for 10d or
-
Benzathine penicillin G 1.2 million U IM once or
-
Amoxicillin 500-875 mg PO q12h or 250-500 PO q8h for 10d
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
Adult dosage if penicillin allergic:
-
Azithromycin 500 mg PO daily for 5d or
-
Clarithromycin 250 mg PO q12h for 10d or
-
Clindamycin 7 mg/kg/day in 3 divided doses (maximum 1.8 g/day) for 10d
Pediatric dosage if penicillin allergic:
-
Azithromycin 12 mg/kg PO once daily for 5d or
-
Clarithromycin 250 mg PO q12h for 10d or
-
Clindamycin 7 mg/kg/day PO in 3 divided doses (maximum 1.8 g/day) for 10d
Arcanobacterium haemolyticum
Suspect when teenager or young adult patient has scarlatiniform rash and negative rapid strep test.
Adult dosage:
-
Erythromycin 250 mg PO QID
Pediatric dosage:
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Erythromycin succinate 20 mg/kg PO BID for 10d
Neisseria gonorrhoeae
Diagnosis should be confirmed by culture on Thayer-Martin medium.
-
Ceftriaxone 125 mg IM once
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Also recommended to treat for Chlamydia trachomatis infection at the same time, unless this organism has been ruled out; treat with azithromycin 1 g PO once or doxycycline 100 mg PO q12h for 7d
Corynebacterium diphtheriae
Extremely rare in the United States; diagnosis should be suspected in cases of pharyngitis with pseudomembranes.
Fusobacterium necrophorum
See the list below:
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More prevalent in patients between ages 14 and 20 years [16]
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Associated with Lemierre syndrome
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Treatment with penicillin or cephalosporin
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Azithromycin resistant