<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 7-year-old boy is brought to the physician because of a 4-day history of fever, headache, earache, and sore throat that is worse when swallowing. He has not had a runny nose or cough. He had a similar problem 1 year ago for which he was prescribed amoxicillin, but after developing a skin rash and facial swelling he was switched to a different medication. His immunizations are up-to-date. He is at the 75th percentile for height and the 50th percentile for weight. His temperature is 38.9C 102F, pulse is 136min, and respirations are 28min. Examination of the oral cavity reveals a coated tongue, red uvula, and enlarged right tonsil covered by a whitish membrane. The deep cervical lymph nodes are enlarged and tender. A throat swab is taken for culture. What is the next most appropriate step in the management of this patient?? A: Penicillin V, B: Total tonsillectomy, C: Fluconazole, D: Erythromycin, E: Cefixime,  <response>: This is a clinical vignette describing a 7-year-old boy with fever, headache, earache, sore throat, enlarged tonsils with exudates, and tender cervical lymphadenopathy. He has a similar episode in the past that was treated with amoxicillin but he developed a rash. The presentation is most consistent with streptococcal pharyngitis strep throat. The next step would be to start empiric antibiotic therapy targeting group A streptococcus while awaiting throat culture results. Penicillin or amoxicillin is usually first-line, but this patient likely has a penicillin allergy, so an alternative agent should be used.Choices A and B are incorrect. Penicillin would not be appropriate in a penicillin-allergic patient. Tonsillectomy is overly aggressive initial management. Choice C, fluconazole, is an antifungal medication and would not cover strep throat. Choice D, erythromycin, is a reasonable alternative antibiotic for penicillin-allergic patients with strep throat.Choice E, cefixime, does not have reliable activity against group A strep.D: Erythromycin 