Which antibiotic is considered first-line therapy for streptococcal pharyngitis?

• A. Penicillin G or VK
• B. Amoxicillin
• C. Macrolides (erythromycin)
• D. Clindamycin

Answer: (A)

Penicillin remains the preferred choice for streptococcal pharyngitis because group A Streptococcus is uniformly susceptible to penicillin, and using a narrow-spectrum, bactericidal agent with proven effectiveness in the throat yields reliable eradication with minimal collateral effects. Penicillin VK (oral) and penicillin G (benzathine, intramuscular) both achieve good pharyngeal concentrations and cure rates, making them first-line options. Amoxicillin is also effective and commonly used, especially in children, but penicillin variants are traditionally cited as the first-line therapy. Alternatives like macrolides are reserved for penicillin-allergic patients, though resistance patterns can limit their usefulness, and clindamycin is not preferred as initial therapy due to side-effect and resistance considerations.