What is the efficacy of penicillin in the treatment of group A beta-hemolytic streptococcal (GABHS) pediatric pharyngitis?

Updated: Dec 11, 2018
  • Author: Harold K Simon, MD, MBA; Chief Editor: Russell W Steele, MD  more...
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Penicillin is the typical therapy for GABHS pharyngitis, in conjunction with prevention of dehydration and supportive care for pain. Improved compliance with regimens has been noted when penicillin treatment is administered 2-3 times daily, as compared with traditional regimens comprising 4 daily doses. Treatment regimens with as few as 2 doses per day have been proved to be effective. [12] Administer a minimum of 20 mg/kg/day; larger children generally should receive 500 mg divided into 2 daily doses for 10 days.

Initial studies using a 5- to 7-day course of penicillin showed a decline in the number of GABHS positive follow-up throat cultures, from 53% to 18%. Subsequent 10-day courses of penicillin proved to be the most beneficial in eradicating GABHS from the pharynx. Therefore, the diagnosis and proper treatment of GABHS are of vital importance.

However, a Cochrane review of 20 studies (including 13,102 acute GABHS pharyngitis cases) that compared short duration of antibiotic therapy with standard duration of therapy for treating acute streptococcal pharyngitis in children determined that short-duration treatment resulted in shorter periods of fever and sore throat, less risk of early clinical treatment failure, and comparable rates of early bacteriologic treatment failure (or late clinical recurrence). [13]

The authors concluded that a 3- to 6-day regimen of oral antibiotics had an efficacy comparable with that of a standard-duration 10-day oral penicillin regimen in treating children with acute GABHS pharyngitis. [13] Shorter courses of antibiotics could limit antibiotic use, reduce cost, and potentially minimize antibiotic resistance; however, the long-term impact on the prevention of rheumatic heart disease is not known and requires further study.

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