GAS Pharyngitis (PCN allergic)

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Cephalexin should be used group A streptococcal pharyngitis in those with a penicillin allergy other than anaphylaxis.

Group A Streptococcus is a relatively common cause of pharyngitis in children. Penicillin and Amoxicillin are first line. Cephalexin should be used in those with a non-anaphylactic penicillin allergy and clindamycin should be used for those with anaphylaxis to penicillins given rare cross reactivity. Macrolides including azithromycin, clarithromycin and erythromycin are alternatives.


Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):e86-102. PMID:22965026.

American Academy of Pediatrics. Group A Streptococcal infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018;