A 10-year-old (35 kg) with rapid strep positive pharyngitis is being discharged on penicillin VK 250 mg PO four times daily for 10 days. Which discharge teaching is most important for the parent?

Penicillin VK is the first-line oral antibiotic for streptococcal pharyngitis caused by group A beta-hemolytic Streptococcus pyogenes. The full 10-day course (or single IM benzathine dose, or 5-day amoxicillin course in some guidelines) is essential to prevent acute rheumatic fever and post-streptococcal glomerulonephritis even after symptoms resolve. Key teaching: (1) complete the full 10-day course on schedule (typically QID for penicillin VK); (2) absorption is best on an empty stomach 1 hour before or 2 hours after meals, but if GI upset occurs giving with food is acceptable; (3) refrigerate suspension and discard after the prescribed period; (4) recognize hypersensitivity — rash, urticaria, angioedema, wheezing, dyspnea — and call for emergency care; mild rash can be non-allergic but should be reported; (5) report severe or bloody diarrhea suggesting C. difficile colitis; (6) return to school is allowed after 12 to 24 hours of antibiotic therapy and being afebrile per CDC and AAP guidance; (7) household contacts who are symptomatic may need testing and treatment; (8) review possibility of OCP backup in adolescents on combined oral contraceptives. Stopping when fever resolves, doubling missed doses, or mixing with milk (calcium-containing fluid can decrease absorption of some related agents though penicillin VK is less affected; still, empty stomach is preferred) are not the priority teaching.

Full 10-day course is the rheumatic fever prevention rule. Empty stomach for absorption, refrigerate suspension, watch for allergy and CDiff.