Treatment of Streptococcus Group C Pharyngitis

Introduction to Treatment

The American Academy of Pediatrics and the Infectious Diseases Society of America recommend that Group C streptococcal pharyngitis should be treated with the same antibiotic regimens as Group A streptococcal (GAS) pharyngitis, as the clinical approach and antimicrobial susceptibility patterns are similar 1, 2, 3

The American Academy of Pediatrics recommends penicillin or amoxicillin as the treatment of choice for non-allergic patients due to proven efficacy, narrow spectrum, safety profile, and low cost 1, 2, 3
Penicillin V is recommended at a dose of 250 mg four times daily or 500 mg twice daily for 10 days in adults 1, 4
Amoxicillin is recommended at a dose of 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg/dose) for 10 days 1, 3, 4

For non-immediate hypersensitivity reactions, first-generation cephalosporins such as cephalexin are preferred alternatives with a cross-reactivity risk of less than 3-10% 1, 4, 5
For immediate/anaphylactic hypersensitivity reactions, clindamycin is the preferred alternative, with macrolides such as azithromycin and clarithromycin as acceptable options 1, 2, 4, 5

The American Academy of Pediatrics and the Infectious Diseases Society of America recommend that all antibiotics except azithromycin require a full 10-day course to achieve maximal pharyngeal eradication and prevent complications 1, 2, 3, 4

The American Academy of Pediatrics recommends analgesics/antipyretics such as acetaminophen or NSAIDs for moderate to severe symptoms or high fever 1, 2, 4

The Infectious Diseases Society of America advises against using tetracyclines, sulfonamides, and trimethoprim-sulfamethoxazole due to high prevalence of resistant strains or lack of efficacy 3, 4
The American Academy of Pediatrics recommends avoiding cephalosporins in patients with immediate/anaphylactic penicillin reactions due to 10% cross-reactivity risk 3, 4

The American Academy of Pediatrics and the Infectious Diseases Society of America recommend against routine posttreatment throat cultures or rapid antigen tests, but suggest reevaluation for patients with worsening symptoms after 48-72 hours or symptoms lasting more than 5 days after treatment initiation 1, 2
The American Academy of Pediatrics recommends against diagnostic testing or empiric treatment of asymptomatic household contacts, as penicillin prophylaxis has not been shown to reduce subsequent infection rates 1, 2, 6