- Sore throat or sore neck.
- Swollen lymph nodes in the neck.
- Nausea, abdominal pain, and sometimes vomiting.
- Confluent red or pink rash which feels rough to the touch, involving the face, trunk, or groin area.
- In rare cases, excessive drooling, inability to open the mouth, stiff neck, large neck mass, or bulging of the tonsil or surrounding tissues. These might signal abscess formation.
- Cough and runny nose are not typical symptoms of streptococcal throat infection.
- Antimicrobial therapy should not be given to a child with pharyngitis in the absence of identified group A streptococci, except in the rare instance of other bacterial causes.
- Penicillin based drugs, including amoxicillin, are the drug of first choice, because resistance of GAS to penicillin has never been documented.
- Intramuscular penicillin G given in a single dose is appropriate therapy.
- Oral cephalosporin antibiotics are an acceptable alternative to penicillin based drugs, especially in those patients with mild penicillin allergy. Up to 15% of patients who are allergic to penicillin will also be allergic to cephalosporin based drugs.
- For patients with severe allergy to penicillin the best choice may be erythromycin or other antibiotics in the same family.
- For those patients with recurrence of streptococcus shortly after completing a course of antibiotics, there is differing opinion about re-treatment. Since resistance to penicillin has not been documented, one acceptable alternative is to repeat amoxicillin.
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