Two dosages of clarithromycin for five days, amoxicillin/clavulanate for five days or penicillin V for ten days in acute group A streptococcal tonsillopharyngitis.
BACKGROUND
Short course antimicrobial therapy is suggested for group A streptococcal tonsillopharyngitis.


METHODS
The bacteriologic and clinical efficacies of clarithromycin [30 or 15 mg/kg/day twice daily (b.i.d.)] or amoxicillin/clavulanate (43.8/6.2 mg/kg/day b.i.d.) for 5 days or penicillin V (30 mg/kg/day 3 times a day) for 10 days were compared. In a randomized, open label, parallel group, multicenter study, 626 children (2-16 years old) with tonsillopharyngitis were enrolled; 537 were evaluable for efficacy. Follow-up evaluations were performed at 4-8 and 21-28 days after therapy.


RESULTS
At enrollment, 26% of the Streptococcus pyogenes isolates were clarithromycin-nonsusceptible. All regimens had an apparently similar clinical efficacy. The long term S. pyogenes eradication rates were 102 of 123 (83%) with amoxicillin/clavulanate and 88 of 114 (77%) with penicillin V. In the 30- and 15-mg/kg/day clarithromycin groups, eradication occurred in 71 of 86 (83%) and 59 of 80 (74%) of the clarithromycin-susceptible isolates (P = 0.33), and in 4 of 28 (14%) and 5 of 26 (19%) of the clarithromycin-resistant isolates, respectively (clarithromycin-susceptible versus -resistant, P < 0.0001). Both clarithromycin dosages were well-tolerated.


CONCLUSIONS
In group A streptococcal tonsillopharyngitis, 5 days of clarithromycin or amoxicillin/clavulanate treatment had clinical efficacy comparable with that of 10 days of penicillin V treatment; however, amoxicillin/clavulanate and penicillin V were bacteriologically more effective than clarithromycin because of its failure to eradicate the clarithromycin-resistant S. pyogenes isolates. The 5-day clarithromycin regimens are not recommended for treatment of streptococcal tonsillopharyngitis in areas where in vitro resistance of group A streptococci to clarithromycin is common.
Syrogiannopoulos
George A
GA
Division of Infectious Disease, Department of Pediatrics, University of Patras, Greece. syrogian@otenet.gr
Bozdogan
Bülent
B
Grivea
Ioanna N
IN
Ednie
Lois M
LM
Kritikou
Dimitra I
DI
Katopodis
George D
GD
Beratis
Nicholas G
NG
Applebaum
Peter C
PC
D000208:Acute Disease; D000293:Adolescent; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010404:Penicillin V / Q000008:administration & dosage*; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification; D014069:Tonsillitis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D019980:Amoxicillin-Potassium Clavulanate Combination; D017291:Clarithromycin; D010404:Penicillin V