A 4-year-old child presents with fever, drooling, and 'hot-potato voice.' On examination, there is bulging of the posterior pharyngeal wall. Throat swab Gram stain shows Gram-positive cocci in chains. The organism is beta-hemolytic, bacitracin-sensitive, and PYR-positive. Treatment should be:

• A Amoxicillin-clavulanate for 10 days
• B Azithromycin for 5 days as first choice
• C Penicillin V or amoxicillin for 10 days ✓
• D Clindamycin for 7 days

Explanation

Bacitracin sensitivity, PYR positivity, and beta-hemolysis on blood agar identify Streptococcus pyogenes (Group A Streptococcus). S. pyogenes has never developed clinically significant resistance to penicillin; hence penicillin V (oral) or amoxicillin for 10 days remains the first-line treatment per WHO and IDSA guidelines. Amoxicillin-clavulanate is not needed for a penicillin-susceptible organism. Azithromycin is a second-line option for penicillin-allergic patients. Clindamycin is used for recurrent GAS or severe invasive disease.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.