Group A beta-haemolytic streptococcus (GABHS) is a common bacterial cause of acute pharyngitis. When a patient has a confirmed or suspected allergy to penicillin or other beta-lactam antibiotics, the usual first-line agents are contraindicated and an alternative class must be selected.
This protocol addresses acute pharyngitis caused by GABHS specifically in patients with confirmed or suspected allergy to penicillin or beta-lactam antibiotics. The allergy status is the defining factor that shapes antibiotic selection in this population.
When beta-lactam allergy is present, antibiotic treatment draws on alternative classes — macrolides (with particular attention to the specific macrolide subtype due to resistance patterns) and lincosamide antibiotics. The complete choice of agent and course depends on individual clinical factors detailed in the full protocol.
Macrolides and lincosamides (clindamycin) are considered the treatment of choice in patients who are allergic, or suspected to be allergic, to β-lactam antibiotics.
If there is confirmed allergy to penicillin, it is advised that clindamycin 300 mg/8 h is used for 10 days or a 16-atom macrolide such as josamycin 1 g/12 h for 10 days, since GABHS resistance, although it has decreased in recent years, remains greater to 14 and 15-atom macrolides than to 16-atom macrolides.
Diacetylmidecamycin 600 mg/12 h 10 days
DOI: 10.1016/j.otoeng.2015.05.003
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