Case 1: Group A streptococcal (GAS) pharyngitis (or strep throat) is the most common bacterial cause of acute pharyngitis and is responsible for 20%–30% of all sore throat visits to pediatricians. GAS pharyngitis is most commonly diagnosed in children 5–15 years of age during the winter and early spring (ie, November–May).
Testing for GAS pharyngitis using a rapid antigen detection test or culture allows clinicians to distinguish between GAS and viral pharyngitis, and consequently, determine which patients receive antibiotics (since antimicrobial therapy has not been shown to be beneficial in the treatment of acute pharyngitis due to organisms other than GAS). Testing for GAS is generally indicated in children complaining of a sore throat, except when clinical features strongly suggest a viral etiology (eg, cough, rhinorrhea, hoarseness and/or oral ulcers).
Based upon the time of year and IC’s age and reported symptoms, it would seem reasonable for the pharmacist to recommend IC be tested for strep throat
Case 2: According to Infectious Disease Society of America (IDSA) treatment guidelines, either penicillin or amoxicillin (for 10-days) are the antibiotics of choice for treating children diagnosed with acute GAS pharyngitis. These agents are preferred because of their narrow spectrum of activity, infrequency of adverse reactions and lower cost. However, because IC has previously experienced an allergic reaction when taking penicillin, an alternative agent should be considered. Guidelines suggest penicillin-allergic patients receive oral clindamycin (7 mg/kg/ dose 3 times daily, max=300 mg/dose) or clarithromycin (7.5 mg/kg/dose twice daily, max=250 mg/dose) for 10 days, or oral azithromycin (12 mg/kg once daily, max=500 mg) for 5 days. In addition, SC could consider giving her daughter acetaminophen or an NSAID (not aspirin) if moderate-to-severe symptoms persist or to control a high fever if it occurs.
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