I went home that night, read the paper and tweeted Ryan. He and Dr. Graham Walker (MD Calc) were already having a conversation about the issue and I asked them what their second line choice of antibiotic is?
Finally, I went on my favorite quick reference resource WikEM . Their entry on strep pharyngitis was recommending azithromycin as the second line drug. I updated the site, and referenced the article.
This is a 3-part guest series by Dr. Timothy Peck, who is launching his own blog at ModernEM.blogspot.com . Check it out!