title: Efficacy of cephalexin two vs. three times daily vs. cefadroxil once daily for streptococcal tonsillopharyngitis.
abstract: The purpose of this study was to compare the bacteriologic and clinical efficacy of oral cephalexin twice vs. three times daily vs. cefadroxil once daily as therapy for group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis. A prospective open-label, observational cohort study was conducted over 18 months (January 2000-June 2001). Children enrolled had an acute onset of symptoms and signs of a tonsillopharyngeal illness and a laboratory-documented GABHS infection. Follow-up examination and laboratory testing occurred 21 +/- 4 days following enrollment. Two hundred seventy-one patients were enrolled (intent to treat group): 63 received cephalexin twice daily, 124 received cephalexin three times daily, and 84 received cefadroxil once daily. Fifty-three children did not return for the follow-up visit, leaving 218 patients in the per-protocol group: 54 cephalexin twice-daily treated, 94 cephalexin 3-times daily treated, and 70 cefadroxil once-daily treated. In the per-protocol group, bacteriologic cure for those treated with cephalexin twice daily was 87%, for cephalexin 3 times daily, it was 81% and for cefadroxil once daily it was 81% (p = 0.61). The clinical cure rate for cephalexin twice-daily treatment was 91%; for three-times daily, it was 86%; and for cefadroxil once daily, it was 84% (p = 0.56). Because treatment allocation was not randomized, logistic regression analysis was used to adjust for treatment group differences. Younger age of patient was significantly associated with bacteriologic (p = 0.04) and clinical (p = 0.01) failure independent of treatment group but in the adjusted logistic model no differences were found among the 3 treatment regimens. Cephalexin dosed twice daily or three times daily and cefadroxil dosed once daily appear equivalent in bacteriologic and clinical cure of GABHS tonsillopharyngitis.
authors.affiliation: Elmwood Pediatric Group, Rochester, New York 14642, USA.
authors.forename: Correne D
authors.initials: CD
authors.lastname: Curtin
authors.forename: Janet R
authors.initials: JR
authors.lastname: Casey
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Murray
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Cleary
authors.forename: William J
authors.initials: WJ
authors.lastname: Hoeger
authors.forename: Steven M
authors.initials: SM
authors.lastname: Marsocci
authors.forename: Marie Lynd
authors.initials: ML
authors.lastname: Murphy
authors.forename: Anne B
authors.initials: AB
authors.lastname: Francis
authors.forename: Michael E
authors.initials: ME
authors.lastname: Pichichero
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002434:Cefadroxil / Q000008:administration & dosage*; D002506:Cephalexin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010612:Pharyngitis / Q000188:drug therapy*; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy*; D013297:Streptococcus pyogenes; D014069:Tonsillitis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002434:Cefadroxil; D002506:Cephalexin