Antibiotic class | Drug | Dosing in children and adolescents* | Advantages | Disadvantages |
Penicillins (preferred) | Penicillin V |
|
|
|
Amoxicillin* |
|
| ||
Penicillin G benzathine (Bicillin L-A) |
|
|
| |
Cephalosporins (potential alternatives for mild reactions to penicillin◊) | Cephalexin* (first generation) |
|
|
|
Cefuroxime* (second generation) |
|
|
| |
Cefpodoxime* (third generation) |
|
|
| |
Cefdinir* (third generation) |
|
|
| |
Macrolides (alternatives for patients with anaphylaxis or other IgE-mediated reactions or severe delayed reactions to penicillin◊) | Azithromycin |
|
|
|
Clarithromycin* |
|
| ||
Lincosamides (alternative when macrolide resistance is a concern and penicillins and cephalosporins cannot be used) | Clindamycin |
|
|
IM: intramuscularly; FDA: US Food and Drug Administration; TdP: torsades de pointes.
* Dose alteration may be needed for renal insufficiency.
¶ Once-daily extended-release amoxicillin is recommended by the 2009 American Heart Association guidelines but is not available in all regions. It is noninferior to immediate release amoxicillin administered in multiple daily doses. The dose in adolescents 12 years and older is 775 mg orally once daily for 10 days.
Δ In children weighing ≤27 kg, the combination IM formulation of 900,000 units benzathine penicillin G with 300,000 units procaine penicillin G (Bicillin C-R 900/300) is a less painful alternative. Efficacy in larger children and adults has not been established.
◊ Approach to patients with penicillin allergy varies among experts and allergy severity; refer to UpToDate text for additional details.Data from: