Treatment of Group G Streptococcal Pharyngitis

First-Line Treatment Approach

The American Academy of Pediatrics recommends penicillin as the treatment of choice for Group G streptococcal pharyngitis due to its proven efficacy, safety, narrow spectrum, and low cost 1, 2
The Infectious Diseases Society of America suggests oral penicillin V dosing for children at 250 mg twice or three times daily for 10 days, and for adolescents and adults at 250 mg four times daily or 500 mg twice daily for 10 days 4
The Centers for Disease Control and Prevention recommend amoxicillin as an equally effective alternative, often preferred in young children, dosed at 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg) for 10 days 4
The American College of Physicians recommends intramuscular benzathine penicillin G for patients unlikely to complete a full 10-day oral course 1, 2

The American Academy of Allergy, Asthma, and Immunology suggests first-generation cephalosporins (e.g., cephalexin 20 mg/kg twice daily, maximum 500 mg/dose) for 10 days as an alternative for non-immediate hypersensitivity reactions 4, 3
The Infectious Diseases Society of America recommends clindamycin for 10 days (7 mg/kg three times daily, maximum 300 mg/dose) for immediate-type hypersensitivity 5, 4
The American College of Physicians suggests macrolides (erythromycin, azithromycin) as suitable alternatives, though macrolide resistance should be considered 1, 5, 4

The Centers for Disease Control and Prevention recommend a full 10-day course for all oral antibiotics except azithromycin to achieve maximal pharyngeal eradication and prevent complications 4, 3
The American Academy of Pediatrics states that azithromycin requires only 5 days due to its prolonged tissue half-life 3
The Infectious Diseases Society of America warns that shorter courses increase the risk of treatment failure and complications 4, 3

The American College of Physicians prioritizes prevention of suppurative complications (peritonsillar abscess, cervical lymphadenitis, mastoiditis) as the primary concern with Group G streptococcus 4
The American Academy of Pediatrics aims to abate clinical symptoms and reduce transmission to close contacts 1
The Infectious Diseases Society of America seeks to minimize adverse effects from inappropriate antimicrobial therapy 1

The Centers for Disease Control and Prevention advise against using shorter antibiotic courses (<10 days for oral therapy) despite some literature suggesting efficacy 4
The American College of Physicians recommends avoiding routine post-treatment testing in asymptomatic patients who completed therapy 5, 4
The Infectious Diseases Society of America warns against prescribing tetracyclines, sulfonamides, trimethoprim-sulfamethoxazole, or older fluoroquinolones, which are not effective against streptococci 5
The American Academy of Allergy, Asthma, and Immunology advises against cephalosporins in patients with immediate-type hypersensitivity to penicillin due to 10% cross-reactivity risk 4, 3