Which antibiotic regimen is appropriate for treating streptococcal pharyngitis to prevent rheumatic fever?

• A. Azithromycin for 5 days.
• B. Amoxicillin for 5 days.
• C. Penicillin or amoxicillin for 10 days.
• D. Clarithromycin for 7 days.

Answer: (C)

Preventing rheumatic fever after a sore throat caused by group A Streptococcus hinges on completely eradicating the bacteria with an adequately long course of a penicillin-type antibiotic. Penicillin V or amoxicillin given for 10 days reliably clears GAS and has the strongest evidence for reducing rheumatic fever risk, making it the standard approach. Amoxicillin is a convenient alternative with similar efficacy, especially in children, but the key is the 10-day duration to ensure complete eradication. Shorter courses with macrolides like azithromycin or clarithromycin do not have the same proven protection against rheumatic fever, and guidelines emphasize the 10-day regimen with penicillin or amoxicillin as the best option for this purpose.