During a visit to the student health clinic, a 20-year-old male describes a sudden onset of severe throat pain and subjective fever over the past 24 hours. He reports no cough or rhinorrhea. Vital signs reveal a temperature of 38.3°C (101.0°F). Physical examination demonstrates bilateral tonsillar erythema with purulent exudates and tender anterior cervical lymph nodes. A rapid antigen detection test for Group A Streptococcus is positive. Which of the following is the most appropriate antimicrobial regimen for this patient?
- AOral amoxicillin-clavulanate
- BOral levofloxacin
- Oral penicillin VAnswer
- DIntravenous ceftriaxone
- EOral azithromycin
Answer
Oral penicillin V
The patient has a confirmed Group A Streptococcus (S. pyogenes) pharyngitis. S. pyogenes is universally susceptible to penicillin. Therefore, targeted, narrow-spectrum therapy with oral penicillin V (or oral amoxicillin) is the treatment of choice. This approach ensures effective bacterial eradication, prevents acute rheumatic fever, and heavily aligns with antibiotic stewardship principles by avoiding unnecessary broad-spectrum coverage.
Step-by-Step Solution
Key Concept
Group A streptococcal pharyngitis should be treated with narrow-spectrum penicillins (e.g., oral penicillin V or amoxicillin) to effectively eradicate the pathogen and prevent complications while strictly adhering to antibiotic stewardship principles.