›Symptom control
›Acetaminophen PO 15 mg/kg per dose every 6 hours
›Maximum 1 g per dose
›Maximum 4 g per day
›Ibuprofen PO 10 mg/kg per dose every 6 to 8 hours
›Adult typical 400 mg every 6 to 8 hours
›Maximum 2400 mg per day for self care context
›Oral hydration
›Warm fluids
›Cold fluids as tolerated
›Salt water gargles
›Throat lozenges if age appropriate
›Corticosteroid for severe pain
›Dexamethasone PO or IM 0.6 mg/kg once
›Maximum 10 mg once
›Evidence level: moderate evidence for pain reduction, not routine for all
Antibiotics for confirmed or strongly suspected GAS
›First line regimens
›Penicillin V PO
›Adults 500 mg twice daily for 10 days
›Children 250 mg twice daily for 10 days
›Evidence level: guideline based (Class I equivalent)
›Amoxicillin PO
›50 mg/kg once daily for 10 days
›Maximum 1000 mg once daily
›Alternative 25 mg/kg twice daily for 10 days
›Maximum 500 mg per dose
›Benzathine penicillin G IM once
›Weight under 27 kg 600000 units once
›Weight 27 kg or higher 1200000 units once
›Use when adherence concern
›Nonanaphylactic penicillin allergy
›Cephalexin PO
›20 mg/kg per dose twice daily for 10 days
›Maximum 500 mg per dose
›Cefadroxil PO
›30 mg/kg once daily for 10 days
›Maximum 1000 mg once daily
›Anaphylactic penicillin allergy
›Clindamycin PO
›7 mg/kg per dose three times daily for 10 days
›Maximum 300 mg per dose
›Azithromycin PO
›Day 1 12 mg/kg once
›Maximum 500 mg
›Days 2 to 5 6 mg/kg once daily
›Maximum 250 mg
›Local macrolide resistance consideration
›Clarithromycin PO
›7.5 mg/kg per dose twice daily for 10 days
›Maximum 250 mg per dose
Peritonsillar abscess management
›Drainage and adjuncts
›Needle aspiration or incision and drainage
›Airway readiness check before procedure
›Ultrasound guidance when available
›Antibiotics covering GAS and anaerobes
›Amoxicillin-clavulanate PO 875 mg twice daily for 10 to 14 days
›Clindamycin PO 300 to 450 mg three times daily for 10 to 14 days
›Dexamethasone PO or IV 10 mg once for significant edema
Deep neck infection and epiglottitis pathways
›Deep neck infection initial therapy
›Ampicillin-sulbactam IV 3 g every 6 hours
›Ceftriaxone IV 2 g daily plus metronidazole IV 500 mg every 8 hours
›MRSA risk
›Add vancomycin IV 15 to 20 mg/kg per dose every 8 to 12 hours
›Trough guided per local protocol
›ENT consultation early
›Suspected epiglottitis
›Avoid provoking airway collapse
›No tongue depressor exam if drooling or stridor
›Ceftriaxone IV 2 g daily
›Add vancomycin if MRSA risk or severe sepsis
›Airway management in controlled setting
›Evidence level: expert consensus (Class I equivalent)
›Immediate actions
›Erythromycin PO or IV 500 mg four times daily for 14 days
›Penicillin G IV 2 to 3 million units every 4 hours for 14 days
›Diphtheria antitoxin via public health coordination
›Cardiac monitoring for myocarditis risk
›Close contacts prophylaxis per public health
Lemierre syndrome suspected
›Sepsis and thrombophlebitis coverage
›Piperacillin-tazobactam IV 4.5 g every 6 hours
›Ceftriaxone IV 2 g daily plus metronidazole IV 500 mg every 8 hours
›Imaging for internal jugular thrombosis
›Early infectious diseases consultation