Table 4.

Antibiotic therapy for acute pharyngitis

Drug/dosage	Advantages	Disadvantages	Data/Level of evidence [reference]
Penicillin V potassium <23 kg: 250 mg bid or tid × 10 d >23 kg: 500 mg bid or tid × 10 d or 250 mg bid or tid	Inexpensive Narrow spectrum of antibacterial activity Low side effect profile Twice-daily dosing		First drug of choice; reduces streptococcal complications compared with placebo/Aa[39]
Penicillin G benzathine <27 kg: 600,000 U intramuscularly × 1 dose >27 kg: 1.2 million U intramuscularly × 1 dose	Ensures compliance	Pain at injection site Possible allergic reaction Cannot discontinue drug exposure if allergy develops
Erythromycin Estolate 20–30 mg/kg divided bid–qid × 10 d Ethyl succinate or sterate <41 kg: 40 mg/kg/d divided bid–qid × 10 d >41 kg: 400 mg qid × 10 d	Resistance is uncommon in the United States No difference in cure rate with all forms	Gastrointestinal upset	Drug of choice in penicillin-allergic patients Equally as effective as penicillin in preventing all complications of group A streptococcus/Bb [40]
Cephalexin Pediatric: 25–50 mg/kg/d divided bid × 10 d Adults: 500 mg bid × 10 d	Twice-daily dosing	Broader spectrum	Equal cure rate versus oral penicillin/Bb[41]
Clindamycin Pediatric: 20 mg/kg/d divided tid × 10 d Adults: 450 mg/d divided tid × 10 d	Unaffected by beta lactamase Narrow spectrum Eliminates carrier status	Expensive Potential to develop Stevens-Johnson syndrome Pseudomembranous colitis may occur up to several weeks after stopping therapy	Cc[42]

Blank entry, not recommended.

^aLevel A is consistent, good-quality patient-oriented evidence (SORT evidence rating system).

^bLevel B is inconsistent or limited-quality patient-oriented evidence (SORT evidence rating system).

^cLevel C recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening.