Treatment can be delayed for up to 9 days and still prevent major sequelae
Penicillin Options:
Penicillin V 250mg PO BID x 10d (child) or 500mg BID x 10d (adolescent or adult)
Bicillin L-A <27 kg: 0.6 million units; ≥27 kg: 1.2 million units IM x 1
Amoxicillin 500-875 mg PO q12h or 250-500 PO q8h for 10d
Penicillin allergic (mild):
Cefuroxime 10mg/kg PO QID x 10d (child) or 250mg PO BID x 4d
Penicillin allergic (anaphylaxis):
Clindamycin 7.5mg/kg PO QID x 10d (child) or 450mg PO TID x 10d OR
Azithromycin 12mg/kg QD (child) or 500mg on day 1; then 250mg on days 2-5
Consider single dose of dexamethasone 0.6mg/kg PO (Max = 10mg)
Streptococcal pharyngitis
Acute rheumatic fever
Croup
Scarlet fever
Pertussis
Suppurative complications
Rabies
Peritonsillar abscess