Russell Posted July 20, 2013 Share Posted July 20, 2013 Has anyone heard of a change in the recommended dosing regimen of amoxicillin for strep pharyngitis? I'm used to the 875-1000 mg BID for adults and the 50 mg/kg divided BID for kids, both for 10 days. I recently noticed in Epocrates, under the amoxicillin monograph there is a new bolded recommendation: 1000 mg q24 hrs for adults and 50 mg/kg q24 hrs for kids, both for 10 days. The article for strep pharyngitis on the other hand still reflects the BID dosing for adults and the divided dosing for kids (with a 1000 mg daily max rather than what I swear used to be a 1000 mg/dose max). Anyone heard of this? And better yet, does anyone have any references for this change? Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 20, 2013 Moderator Share Posted July 20, 2013 why not pcn? Link to comment Share on other sites More sharing options...
rcdavis Posted July 20, 2013 Share Posted July 20, 2013 I think that you are thinking of the "new augmentin-1000mg XL doses which came out in 2008-ish and reflected a recommendation of "1-2 tabs po bid" giving the patient a total of 2000-4000mg / day of amoxicillin (plus the Clavulanic acid dosages). So you are not wrong. I agree with ventana, penicillin is the way to go, and is the DOC. Or simply a single Bicillin CR injection Link to comment Share on other sites More sharing options...
d2305 Posted July 20, 2013 Share Posted July 20, 2013 Amoxil comes in 875mg now. I don't have a new Sanford, so I've been using it tid. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 20, 2013 Moderator Share Posted July 20, 2013 honestly I think we should go back to doing shots in the office just have to many people coming in saying "I had some left over abx from my last ST so I took them for my 4 days of sinus infection" Bad on two sides, didn't finish the abx for ST and took it wrong for a cold...... Link to comment Share on other sites More sharing options...
bradtPA Posted July 21, 2013 Share Posted July 21, 2013 If going with bicillin, what are your thoughts on also dosing probenacid first? Link to comment Share on other sites More sharing options...
rcdavis Posted July 21, 2013 Share Posted July 21, 2013 There is no real reason to do it.. Probenecid decreases the renal clearance of the penicillin , but with the benzathine penicillin component, there is a longer acting component which precludes the addition of benemid. Link to comment Share on other sites More sharing options...
aquafresh11 Posted July 21, 2013 Share Posted July 21, 2013 The 2012 IDSA guidelines as well as the AHA recommend amoxicillin once a day to treat strep first line (PCN also first line option). Link to comment Share on other sites More sharing options...
CByersPAC Posted July 21, 2013 Share Posted July 21, 2013 I go with the UpToDate recommendation for PCN oral as first line; amox 875 BID (not Augmentin) or 500 TID as an alternative. Smaller doses for people under 27 kg. I have occasionally used amox instead of PCN suspension just because amox is so much tastier; I've had some kids refuse PCN suspension. Don't think I would use Augmentin for strep. Don't need such a broad hammer for such a narrow little nail. Personally I wouldn't go with Bicillin unless there were some overwhelming reason not to use oral, don't see any reason to take that small but potentially serious extra risk of anaphylaxis gratuitously. Link to comment Share on other sites More sharing options...
cbrsmurf Posted July 22, 2013 Share Posted July 22, 2013 Can someone comment on the incidence of side effects of pcn vs amox. I was under the impression the % of GI effects with PCN is much higher. Link to comment Share on other sites More sharing options...
sk732 Posted July 24, 2013 Share Posted July 24, 2013 Pen V is usually taken on an empty stomach - which can add to GI side effects and it's also a convenience issue, having to work your pills and meals around each other. Personally, I still prefer using Pen V over amoxil, especially in the kid/adolescent age groups if I can, simply because if there is an underlying mono with the strep throat, the kid will likely get a wicked rash...it'll tell me about the mono in a hurry, but they often get labelled as Penicilin Allergic. Trying to tell parents that's not the case is as difficult as pulling hens' teeth. If there isn't Pen liquid about for kids (it was DC'd here awhile back for some time), I use cephalexin, cefuroxime or clarithromycin. I usually double up the dose with adults and go bid dosing with the Pen V. SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 26, 2015 Share Posted September 26, 2015 Late night correction. One too many decimals on the Tamiflu. Pricing for ONE dose pak of a quantity of ten >$100. A quantity of TEN dosing paks is over a grand. Four providers this week, including self, failed to pick up on this "minor" detail. Link to comment Share on other sites More sharing options...
RetNavyPAC Posted September 27, 2015 Share Posted September 27, 2015 . . . . It's a self-limited disease with low risk of complications (sinusitis/OM and don't bring up RF/PSGN which are rarely seen present day. . . . Hear, hear! http://www.smartem.org/podcasts/treatment-acute-pharyngitis Should blow your mind and change your practice like it did me 5 years ago. :-) Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 27, 2015 Moderator Share Posted September 27, 2015 strep throat one of the greatest excuses to give ABX.... yes I do still test and treat based on results, and physical exam - yup NASTY looking throats get ABX - not for strep but those other Dx like PTA My take on the whole thing simple Strep throat will not kill you acutely Americans want the cure in a pill there at literately MILLIONS of causes of sore throat - and strep - (oh yeah and not all strep but just the group A beta-hemolytic streptococcal ) The above warrants treatment based on pathogen (and for others like diptheria, GC, PTA and others that should be in the Ddx of sore throat) BUT we are FAR overtreating sore throats with Abx - no idea why this persists but suspect it is "keeping patient happy", easier, less fuss, less follow up, less chance of missing something.......... for the simple sore throat we should all be NOT treating until results are back - if you are testing.... based on results and LOOKING at the throat - for petechia, LAD, Erythema and D/C - if 3 of these are not present - don't treat if typical VIRAL - don't treat If NASTY throat and MONO NEGATIVE - and concern ddx is PTA or other -okay to treat covering the pathogens for your Ddx Stop the sillyness of just giving out ABX for sore throat...... it is wrong..... Link to comment Share on other sites More sharing options...
winterallsummer Posted September 28, 2015 Share Posted September 28, 2015 Yes there is a recent change to dosing indication. That is, 99% of sore throats don't need antibiotics unless a PTA, etc is present. So I believe the new dosage is 0 mg x 0d. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 28, 2015 Share Posted September 28, 2015 I'll be long gone before we un-train the general population yet again to think that strep won't eradicate the world, though I try, one resistant pt/parent at a time. Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
sas5814 Posted September 28, 2015 Share Posted September 28, 2015 Has anyone heard of a change in the recommended dosing regimen of amoxicillin for strep pharyngitis? I'm used to the 875-1000 mg BID for adults and the 50 mg/kg divided BID for kids, both for 10 days. I recently noticed in Epocrates, under the amoxicillin monograph there is a new bolded recommendation: 1000 mg q24 hrs for adults and 50 mg/kg q24 hrs for kids, both for 10 days. The article for strep pharyngitis on the other hand still reflects the BID dosing for adults and the divided dosing for kids (with a 1000 mg daily max rather than what I swear used to be a 1000 mg/dose max). Anyone heard of this? And better yet, does anyone have any references for this change? I generally live and die by the Sandford Guide which says Pen VK 500mg BID x 10 days or Amox 500mg BID x 10 days. Link to comment Share on other sites More sharing options...
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