The “over use” of Penicillin like antibiotics can eradicate the normal flora, leaving only the penicillinase producers.  This can lead to what seem like fairly resistant cases that fail penicillin repeatedly.  If they and family members are asymptomatic, there is no reason to treat.  If the decision is to treat (ASO titers can help with that decision), then Cleocin or Ceftibutin can be considered.  (Cleocin 20 mg/kg/day divided TID for 10 days).  In reality antibiotics have no proven benefit for the treatment of any pharyngitis other than GABHS, Ghonorrhea, or Diptheria.

It is uncertain if the family dog can act as a reservoir or not.  However, there have apparently been case reports, and treating the dog has been suggested by some.

Another consideration is to wash family toothbrushes in top drawer of dish washer on day 1, 5, and 10 of treatment.