Randomized, comparative efficacy trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children.
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.
Meury
Susanne Navarini
SN
Division of Pediatric Infectious Diseases, University Children's Hospital Basel, Basel, Switzerland.
Erb
Thomas
T
Schaad
Urs B
UB
Heininger
Ulrich
U
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
D000900:Anti-Bacterial Agents; D010406:Penicillins; D002444:Cefuroxime