Acute pharyngitis and tonsillitis

500 mg TID or 1000 mg BID x 10 days

40-50 mg/kg/day [child max 1000 mg]

(Divided BID-TID for 10 days to prevent rheumatic fever)

Alternatives. NICE NG84 table 1 puts phenoxymethylpenicillin first, but IDSA 2012 names amoxicillin co-equal for group A Streptococcus, and Egypt stocks 8 amoxicillin products against 2 for penicillin V. Availability decides.

Egyptian National Drug Formulary - Antimicrobial 2023

Aminopenicillin used to eradicate group A Streptococcus from the throat; eradicating the organism, not just easing the sore throat, is what prevents the downstream complication of rheumatic fever.

500 mg QID or 1000 mg BID x 10 days

25-50 mg/kg/day [child max 1000 mg] (Divided QID for 10 days)

Egyptian National Drug Formulary - Antimicrobial 2023

Narrow-spectrum penicillin that remains first-line for streptococcal pharyngitis because group A Streptococcus has not developed resistance to it; eradicating the organism is what prevents rheumatic fever.

Acute Pharyngitis - disease-level clinical article (acute-pharyngitis-clinical.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

IM: 1.2 million units as a single dose - single dose

Infants, Children, and Adolescents: IM: ≤27 kg: 600,000 units as a single dose. >27 kg: 1.2 million units as a single dose.

Egyptian National Drug Formulary - Antimicrobial 2023

Single-dose IM penicillin G benzathine eradicates Group A Streptococcus to prevent acute rheumatic fever.

250-1000 mg every 6 hours, or 500 mg every 12 hours (maximum 4 g/day)

25-50 mg/kg/day [child max 2000 mg]

(ENDF: mild to moderate infection, 25 to 50 mg/kg/day divided every 6 or 12 hours; maximum daily dose 2,000 mg/day.)

Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph)

A first-generation cephalosporin is the option the disease article gives for a non-anaphylactic penicillin reaction; the card previously jumped straight to a macrolide, which the article reserves for true IgE-mediated allergy.

500 mg once daily on day 1, then 250 mg once daily for 4 days x 5 days

12 mg/kg once daily (max 500 mg) on day 1, then 6 mg/kg once daily (max 250 mg) on days 2-5

WATCH group - carries resistance cost. Egyptian EML 2025.

Alternatives, both for the penicillin-allergic patient. Azithromycin is the shorter course and the cheaper (14-126 EGP against 37-299).

IDSA GAS Pharyngitis Guidelines 2012 Table 2 (with 2014 Erratum)

Macrolide alternative for penicillin-allergic patients with streptococcal pharyngitis; kept second-line because macrolide resistance in group A Streptococcus runs higher than penicillin resistance.

250 mg twice daily x 10 days

15 mg/kg/day [child max 500 mg]

(15 mg/kg/day divided BID (max 250 mg twice daily) for 10 days)

WATCH group - carries resistance cost. Egyptian EML 2025.

IDSA GAS Pharyngitis Guidelines 2012 Table 2

Macrolide alternative to penicillin for penicillin-allergic patients with streptococcal pharyngitis, offered for the same resistance reasons as azithromycin.

1000 mg every 6 hours as needed, maximum 4000 mg in 24 hours - while the throat hurts, usually 3-5 days

15 mg/kg/dose [child max 500 mg]

(15 mg/kg per dose every 6 hours - FOUR doses a day at most. Every 4 hours would reach 90 mg/kg/day against a 60 mg/kg/day ceiling. Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).)

Sourced preference. NICE NG84 1.2.1 reads 'Consider paracetamol for pain or fever, or if preferred and suitable, ibuprofen' - paracetamol is named first.

MSF Essential Drugs 2024 - paracetamol (oral)

The sore throat is what the patient came in with, and it needs treating whether or not an antibiotic is written. The dose here is the drug label's. NICE NG84 covers antibiotic prescribing for acute sore throat and recommends paracetamol or ibuprofen for the pain - that comes from a secondary summary rather than the guideline text, so it is stated as background and the dose rests on the label.

400 mg three times daily with or after food, maximum 1200 mg in 24 hours - while the throat hurts, usually 3-5 days

5-10 mg/kg/dose [child max 400 mg]

(5-10 mg/kg per dose every 8 hours - THREE doses a day, not four. Three doses of 10 mg/kg is already 30 mg/kg/day and the label's figure for pain and fever is 20. Never more than 400 mg in one dose and never more than 1200 mg in a day, whatever the weight calculation says.)

StatPearls: Ibuprofen (NCBI Bookshelf NBK542299)

The sore throat is what the patient came in with, and it needs treating whether or not an antibiotic is written. The dose here is the drug label's. NICE NG84 covers antibiotic prescribing for acute sore throat and recommends paracetamol or ibuprofen for the pain - that comes from a secondary summary rather than the guideline text, so it is stated as background and the dose rests on the label.