Several other medications, including some that are more palatable and meet with better compliance, have been approved to treat GABHS pharyngitis. For example, amoxicillin has often been used in place of penicillin; however, neither has been determined to possess a significant microbiologic advantage over penicillin. One preliminary report has shown amoxicillin taken once daily to be effective.
Cephalosporins also have been used, but it is questionable whether failure rates are any better than those achieved with penicillin. Cephalosporins resist degradation by beta-lactamases and are very effective against copathogens. First- or second-generation cephalosporins are preferred. Cephalosporins use to treat pediatric pharyngitis include cephalexin, cefadroxil, cefuroxime, cefixime, cefdinir, and cefpodoxime. Macrolide antibiotics may be recommended for penicillin-allergic patients.
As a rule, relapses or failure to improve should be treated with an antibiotic active against beta-lactamase–producing organisms (eg, a macrolide, a cephalosporin, or amoxicillin-clavulanate). The hypothesis is that colonizing pharyngeal bacteria that produce penicillinase have inactivated penicillin, resulting in treatment failure.
Findings by Hirsh et al report that despite recommendations for amoxicillin or penicillin for treatment of pharyngitis, only 52% of clinicians prescribe the recommended treatment for otitis media, sinusitis, and pharyngitis. [14, 15] A study focusing on inappropriate antibiotic prescriptions by the same team also found that pharyngitis, with 43 antibiotic prescriptions per 1000 population [95% CI, 38-49]), was the third highest diagnosis associated with the most antibiotic prescriptions behind sinusitis and otitis media. [16]
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Posterior pharynx with petechiae and exudates in a 12-year-old girl. Both the rapid antigen detection test and throat culture were positive for group A beta-hemolytic streptococci.
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Streptococcal pharyngitis. Note the redness and edema of the oropharynx and petechiae, or small red spots, on the soft palate caused by strep throat. Strep throat is caused by group A streptococcus bacteria. These bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected or through contact with infected wounds or sores on the skin.
