Streptococcal A information
Strep A is a common type of bacteria. Most strep A infections are mild and easily treated, but some are more serious.
Common symptoms of strep A include:
- flu-like symptoms, such as a high temperature, swollen glands or an aching body
- sore throat (strep throat or tonsillitis)
- a rash that feels rough, like sandpaper (scarlet fever)
- scabs and sores (impetigo)
- pain and swelling (cellulitis)
- severe muscle aches
- nausea and vomiting
Most strep A infections are not serious and can be treated with antibiotics.
But rarely, the infection can cause serious problems. This is called invasive group A strep (iGAS).
It can be difficult to tell when a child is seriously ill, but the main thing is to trust your instincts.
You know better than anyone else what your child is usually like, so you'll know when something is seriously wrong.
If your child does not seem to be seriously ill, you can usually look after them at home. They should feel better in a few days.
If they're uncomfortable, you can give them children's paracetamol or children's ibuprofen. Check the leaflet to make sure the medicine is suitable for your child and to see how much to give them.
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Most strep A infections can be easily treated with antibiotics.
If you or your child has a strep A infection, you should stay away from nursery, school or work for 24 hours after you start taking antibiotics. This will help stop the infection spreading to other people.
Serious strep A infections (invasive group A strep, iGAS) need to be treated in hospital with antibiotics.
Streptococcal A antibiotic information
Due to a national shortage of liquid antibiotics, we have provided the below information for parents:
Children should be encouraged to swallow oral solid dose forms (tablets and capsules) where possible:
- Medicines for Children has useful guides on how to give medicines, including giving tablets and giving capsules.
- KidzMed is an e-Learning resource from Health Education England for healthcare professionals teaching children to swallow pills.
Paediatric antibiotic suspensions and some whole oral dosage forms are licensed for use in children at a variety of ages.
Where children are unable to swallow whole oral dosage forms, we provide advice on how to give doses by dispersing or crushing tablets or by opening capsules. Use in this way may be outside the product licence and is thus “off-label”.
Phenoxymethylpenicillin tablets are available in a 250mg strength.
Dispersing or crushing
They are film-coated but can be dispersed in water, or crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a penicillin allergy.
Dispersing tablets
To disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.
Masking the taste
The dispersed or crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
Phenoxymethylpenicillin would normally be given half an hour before food as food slightly decreases the peak plasma concentration of the drug; however, the manufacturer acknowledges food does not appear to affect the extent of absorption.
Clarithromycin immediate-release tablets are available as 250mg and 500mg strengths.
Dispersing or crushing
They are film-coated but can be crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a macrolide allergy. The modified-release tablets must not be crushed.
Dispersing tablets
To disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.
Masking the taste
The crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
Erythromycin tablets are available as 250mg and 500mg strengths. Some are film coated and some are enteric coated.
Dispersing or crushing
The film-coated tablets can be crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a macrolide allergy. Enteric coated tablets should not be crushed.
Dispersing tablets
To disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.
Masking the taste
The crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
Note that some generic products advise to give one hour before food, however this may not be necessary and is not practical in this situation.
Amoxicillin capsules are available in 250mg and 500mg strengths.
Opening and dispersing
The capsules can be opened and the contents tipped out and mixed with liquid or soft food. However, this should not be undertaken by anyone with a penicillin allergy.
Masking the taste
The capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the powder with food or drink, give it straight away
Azithromycin capsules are available in a 250mg strength.
Opening and dispersing
They can be opened and the contents tipped out and mixed with liquid or soft food. However, this should not be performed by anyone with a macrolide allergy.
Masking the taste
The capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the powder with food or drink, give it straight away
Absorption of azithromycin capsules (but not tablets or oral suspension) can be decreased by food; however, it is not clear whether absorption of opened capsules is affected.
Cefalexin capsules are available as 250mg and 500mg strengths.
Opening and dispersing
They can be opened and the contents tipped out and mixed with liquid or soft food. However, this should not be performed by anyone with penicillin or cephalosporin allergy.
Masking the taste
The capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the powder with food or drink, give it straight away
Dispersing or crushing
They are film-coated but can be crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a penicillin or cephalosporin allergy.
Dispersing tablets
To disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.
Masking the taste
The crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
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