# 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? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375220&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question 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? ## Option 1. Mix the penicillin with milk or a dairy product to enhance absorption and minimize stomach upset; if the child refuses due to taste, you may skip the dose; continue the antibiotic until the fever resolves and then stop to prevent resistance; the suspension does not need refrigeration and can be kept at room temperature for convenience; watch for mild diarrhea which is common and no cause for concern; the child may return to school as soon as the sore throat improves. 2. You may give the morning and afternoon doses together at breakfast to reduce school-day interruptions; if a dose is missed, double the next dose; the antibiotic can be stopped once the child is afebrile for 24 hours; store the suspension in the pantry to maintain potency; expect a red rash on the trunk as a normal drug reaction and continue the medication; the child can return to school as soon as they feel well enough, no need to wait. 3. Stop giving the penicillin when the child's fever subsides, usually after 2 to 3 days, to reduce the risk of side effects; give each dose with a full glass of milk to protect the stomach; the suspension can be kept at room temperature and used for future infections if needed; watch for mild diarrhea which is expected and not reportable; the child may return to school once a repeat rapid strep test is negative. 4. Give every dose on schedule for the full 10 days even if symptoms improve to prevent rheumatic fever and glomerulonephritis; take on an empty stomach 1 hour before or 2 hours after meals when feasible for best absorption; refrigerate the suspension and discard after the prescribed period; report rash, hives, swelling, wheezing, severe diarrhea, or bloody stool; the child can return to school after 12 to 24 hours of antibiotic and being afebrile. **✔ Correct answer** **Correct answer: 4** ## Explanation 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. ## In-depth explanation Full 10-day course is the rheumatic fever prevention rule. 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