Amoxicillin for fever and sore throat due to non-exudative pharyngotonsillitis: beneficial or harmful?
OBJECTIVE
To determine duration of signs and symptoms and adverse reactions after treatment with amoxicillin of patients with fever and sore throat due to non-exudative pharyngotonsillitis.


METHODS
This was a randomized, double-blinded, placebo-controlled trial. Outpatients at four medical centers were enrolled. Patients over 5 years of age presented with fever and sore throat for less than 10 days due to non-exudative pharyngotonsillitis. Cases with any of the following symptoms or illness were excluded: earache, nasal discharge with foul smell, rheumatic fever, valvular heart disease, renal disease, and penicillin hypersensitivity. Amoxicillin or identical placebo at the dosage of 50 mg/ kg per day was given three or four times daily for 7 days.


RESULTS
There were 1217 patients enrolled in this study. Some were lost to follow-up, which is the reason for the variability in number of cases in these analyses. After therapy, duration of fever was 2.46 and 2.48 days (P = 0.78) and of sore throat 3.01 and 3.04 days (P = 0.80) in amoxicillin (n = 431) and placebo (n = 436) groups, respectively. Complications were clinically documented in 13 (2.5%) and 16 (3.0%) cases in amoxicillin (n = 527) and placebo (n = 524) groups (P = 0.56). Two cases (0.46% and 0.46%) from each group (n= 433 and 431) were positive by antistreptolysin O antibody determination. The history of carditis and abnormal urinalysis after treatment were not obtained.


CONCLUSIONS
Amoxicillin therapy for non-exudative pharyngotonsillitis conferred no beneficial or harmful effect.
Leelarasamee
A
A
Department of Medicine, Division of Infectious Diseases Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok. siall@mahidol.ac.th
Leowattana
W
W
Tobunluepop
P
P
Chub-upakarn
S
S
Artavetakun
W
W
Jarupoonphol
V
V
Varangphongsri
K
K
Leelarasamee
I
I
D000234:Adenoids / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use*; D000989:Antistreptolysin / Q000097:blood; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005334:Fever; D006801:Humans; D008297:Male; D010406:Penicillins / Q000009:adverse effects / Q000627:therapeutic use*; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology; D013297:Streptococcus pyogenes; D014069:Tonsillitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology
D010406:Penicillins; D000658:Amoxicillin; D000989:Antistreptolysin