For persons allergic to β-lactams
Erythromycin ethyl succinate: 40–50 mg/kg/day (max 1 g/day) in 3–4 doses for 10 days
Erythromycin estolate: 20–40 mg/kg/day in 2–4 doses (max 1 g/day) for 10 days
Azithromycin, children: 12 mg/kg orally once daily for 5 days (to maximum adult dose); adults: 500 mg orally on day 1, then 250 mg orally on days 2–5
BID, Twice daily; OD, once daily; TID, three times daily.
penicillin. One proposed explanation is that staphylococci or anaerobes in the pharynx produce β-lactamase, which inactivates penicillin and reduces its efficacy. Another possible explanation is that cephalosporins are more effective in eradicating streptococcal carriage.
Children with recurrent throat culture episodes of group A streptococcal pharyngitis pose a particular problem. An alternative antibiotic may be chosen to treat β-lactamase producing flora, which may be responsible for the recurrences. Either amoxicillin-clavulanate or clindamycin is an effective regimen for eliminating streptococcal carriage.
Specific antiviral therapy is unavailable for most cases of viral pharyngitis. Patients with primary herpetic gingivostomatitis benefit from early treatment with oral acyclovir.
Pharyngitis caused by streptococci or respiratory viruses usually resolves completely. The complications of group A streptococcal pharyngitis include local suppurative complications, such as parapharyngeal abscess and other infections of the deep fascial spaces of the neck, and nonsuppurative complications, such as acute rheumatic fever and acute postinfectious glomerulonephritis. Viral respiratory tract infections, including infections caused by influenza A, adenoviruses, parainfluenza type 3, and rhinoviruses, may predispose to bacterial middle ear infections.
Antimicrobial prophylaxis with daily oral penicillin V prevents recurrent streptococcal infections and is recommended only to prevent recurrences of rheumatic fever.
Sinusitis is a suppurative infection of the paranasal sinuses and often complicates the common cold and allergic rhinitis. The maxillary and ethmoid sinuses are present at birth, but only the ethmoidal sinuses are pneumatized. The maxillary sinuses become pneumatized at 4 years of age. Frontal sinuses begin to develop at 7 years of age and are not completely developed until adolescence. The sphenoid sinuses are present by 5 years of age. The ostia draining the sinuses are narrow (1 to 3 mm) and drain into the middle meatus in the ostiomeatal complex. The mucociliary system maintains the sinuses as normally sterile.