title: Randomized, comparative efficacy trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children.
abstract: OBJECTIVE
  To investigate the efficacy of penicillin compared with cefuroxime for group A beta-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis.
  
  
  METHODS
  Children 1 to 16 years of age with signs and symptoms of perianal dermatitis and a positive anal swab were randomized to penicillin or cefuroxime treatment and were clinically re-evaluated on day 3 and at the end of treatment (cefuroxime, day 7; penicillin, day 10). An anal swab was obtained to document eradication of GABHS at the end of treatment. Severity of disease was assessed with a clinical score (perianal erythema, 5 points; perianal itch, 3 points; painful defecation, 3 points; constipation, 2 points).
  
  
  RESULTS
  Patients were enrolled and randomly assigned to penicillin (n = 18) or cefuroxime (n = 17) treatment. Treatment with penicillin was inferior to cefuroxime, which led to premature study termination after consultation with the ethics committee. Clinical improvement was more rapid in the cefuroxime group (P = .028) and GAHBS was not isolated from the anus the last day of therapy in 13 of 14 patients treated with cefuroxime compared with 7 of 15 patients treated with penicillin (P < .01).
  
  
  CONCLUSIONS
  Cefuroxime was more effective than penicillin and therefore should be considered as the treatment of choice for perianal dermatitis due to GABHS.
authors.affiliation: Division of Pediatric Infectious Diseases, University Children's Hospital Basel, Basel, Switzerland.
authors.forename: Susanne Navarini
authors.initials: SN
authors.lastname: Meury
authors.forename: Thomas
authors.initials: T
authors.lastname: Erb
authors.forename: Urs B
authors.initials: UB
authors.lastname: Schaad
authors.forename: Ulrich
authors.initials: U
authors.lastname: Heininger
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001004:Anus Diseases / Q000145:classification / Q000188:drug therapy* / Q000382:microbiology; D002444:Cefuroxime / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D003872:Dermatitis / Q000145:classification / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000145:classification / Q000188:drug therapy*; D013292:Streptococcus agalactiae / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002444:Cefuroxime