Treatment of pharyngitis and tonsillitis caused by Streptococcus pyogenes (group A β-hemolytic streptococci).
AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice; oral cephalosporins and oral macrolides are considered alternatives. Amoxicillin sometimes used instead of penicillin V, especially for young children.
A second episode can be retreated with the same or other treatment of choice; other regimens (amoxicillin and clavulanate, clindamycin, penicillin G benzathine with or without rifampin) recommended for symptomatic patients with multiple, recurrent episodes.
Consider that multiple, recurrent episodes of symptomatic pharyngitis within several months to years may be repeated episodes of nonstreptococcal (e.g., viral) pharyngitis in a streptococcal carrier; treatment not usually recommended for streptococcal pharyngeal carriers.
Other Streptococcal Infections
Treatment of mild to moderately severe infections (without bacteremia) caused by susceptible streptococci, including upper respiratory tract infections and scarlet fever. Usually active against streptococci groups A, C, G, H, L, and M.
Treatment of mild to moderate respiratory tract infections caused by susceptible S. pneumoniae (MIC <0.1 mcg/mL); however, other penicillins (penicillin G, amoxicillin, amoxicillin and clavulanate, ampicillin and sulbactam) usually recommended when a penicillin used for treatment of these infections.
Skin or Skin Structure Infections
Treatment of mild skin or skin structure infections caused by susceptible nonpenicillinase-producing staphylococci or susceptible streptococci (e.g., erysipelas).
Not considered a drug of choice; susceptibility needs to be confirmed with in vitro testing because of high incidence of penicillinase-producing staphylococci.
Prevention of Rheumatic Fever Recurrence
Prevention of recurrence of rheumatic fever (secondary prophylaxis). Continuous prophylaxis recommended following treatment of documented rheumatic fever (even if manifested solely by Sydenham chorea) and in those with evidence of rheumatic heart disease.
AHA recommends IM penicillin G benzathine, oral penicillin V, or oral sulfadiazine for such prophylaxis.
Prevention of Bacterial Endocarditis
Prevention of bacterial endocarditis in patients with congenital heart disease or rheumatic or other acquired valvular heart disease undergoing certain dental or upper respiratory tract procedures.
Not a drug of choice; AHA recommends amoxicillin for prevention of bacterial endocarditis in high- or moderate-risk patients undergoing certain dental, oral, respiratory tract, or esophageal procedures.
Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis.
Prevention of S. pneumoniae Infections in Asplenic Individuals
Prevention of S. pneumoniae infections in children with anatomic or functional asplenia† (e.g., congenital, as the result of sickle cell disease or splenectomy), children with malignant neoplasms or thalassemia, and asplenic adults (e.g., after splenectomy for trauma).
Usually drug of choice for prophylaxis in asplenic children; some experts recommend amoxicillin.
Children at increased risk for pneumococcal infections should receive pneumococcal 7-valent conjugate vaccine and pneumococcal 23-valent polysaccharide vaccine. Long-term anti-infective prophylaxis recommended for children with anatomic or functional asplenia regardless of vaccination status.
An alternative for postexposure prophylaxis of anthrax† following exposure to Bacillus anthracis spores (inhalational anthrax). Ciprofloxacin or doxycycline are initial drugs of choice for postexposure prophylaxis following suspected or confirmed bioterrorism-related anthrax exposure. If penicillin susceptibility is confirmed, consideration can be given to changing prophylaxis to a penicillin in infants and children and in pregnant or lactating women; amoxicillin usually is recommended.
Treatment of mild, uncomplicated cutaneous anthrax† caused by susceptible B. anthracis that occurs as the result of naturally occurring or endemic exposure to anthrax. If cutaneous anthrax occurs in the context of biologic warfare or bioterrorism, initial drugs of choice are ciprofloxacin or doxycycline. If penicillin susceptibility is confirmed, consideration can be given to changing to a penicillin in infants and children or in pregnant or lactating women; amoxicillin usually is recommended.
Actinomycosis
Follow-up treatment of actinomycosis† after initial treatment with parenteral penicillin G or ampicillin.
Follow-up treatment of rat-bite fever† caused by Streptobacillus moniliformis in afebrile patients who respond to initial treatment with parenteral penicillin G.
Whipple’s Disease
Follow-up treatment of Whipple’s disease† after initial therapy with parenteral penicillin G.
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