For streptococcal pharyngitis, what is the treatment of choice in a patient without penicillin allergy?

• A. Penicillin VK
• B. Sulfasoxazole
• C. Tetracycline
• D. Floxacin

Answer: (A)

Treating streptococcal pharyngitis with a drug that reliably kills group A Streptococcus using a safe, inexpensive, and easy-to-take regimen is the goal. In patients without penicillin allergy, penicillin V is the drug of choice because GAS remains fully susceptible to penicillin, and the oral form provides effective, short-course therapy with a narrow spectrum that minimizes disruption to normal flora and avoids driving resistance. It’s proven, well-tolerated, and cost-efficient, making it the best option for first-line treatment. The other choices either don’t effectively cover GAS or carry more safety concerns or stewardship issues: sulfonamides have poor activity against GAS, tetracycline has limited activity and is often avoided in children and pregnant patients, and fluoroquinolones are broad-spectrum with higher risks and are not preferred for straightforward GAS pharyngitis.