Meta-analysis of cephalosporins versus penicillin for treatment of group A streptococcal tonsillopharyngitis in adults.
We conducted a meta-analysis of 9 randomized controlled trials (involving 2113 patients) comparing cephalosporins with penicillin for treatment of group A beta -hemolytic streptococcal (GABHS) tonsillopharyngitis in adults. The summary odds ratio (OR) for bacteriologic cure rate significantly favored cephalosporins, compared with penicillin (OR,1.83; 95% confidence interval [CI], 1.37-2.44); the bacteriologic failure rate was nearly 2 times higher for penicillin therapy than it was for cephalosporin therapy (P=.00004). The summary OR for clinical cure rate was 2.29 (95% CI, 1.61-3.28), significantly favoring cephalosporins (P<.00001). Sensitivity analyses for bacterial cure significantly favored cephalosporins over penicillin in trials that were double-blinded and of high quality, trials that had a well-defined clinical status, trials that performed GABHS serotyping, trials that eliminated carriers from analysis, and trials that had a test-of-cure culture performed 3-14 days after treatment. This meta-analysis indicates that the likelihood of bacteriologic and clinical failure in the treatment of GABHS tonsillopharyngitis is 2 times higher for oral penicillin than for oral cephalosporins.
Casey
Janet R
JR
University of Rochester, Elmwood Pediatric Group, Rochester, New York 14620, USA. jrcasey@rochester.rr.com
Pichichero
Michael E
ME
D000328:Adult; D002511:Cephalosporins / Q000627:therapeutic use*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D010406:Penicillins / Q000627:therapeutic use*; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology*; D016032:Randomized Controlled Trials as Topic; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000302:isolation & purification; D014069:Tonsillitis / Q000188:drug therapy* / Q000382:microbiology*; D016896:Treatment Outcome
D002511:Cephalosporins; D010406:Penicillins