title: Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin G in low-resource settings: a randomized controlled trial.
abstract: BACKGROUND
  Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β -hemolytic streptococcal (GAS) pharyngitis.
  
  
  METHODS
  To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia.
  
  
  RESULTS
  A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference).
  
  
  CONCLUSIONS
  If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.
authors.affiliation: Department of Epidemiology, UCLA School of Public Health, CHS 41-245, Los Angeles, CA 90005, USA. arimoin@ucla.edu
authors.forename: Anne W
authors.initials: AW
authors.lastname: Rimoin
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Hoff
authors.forename: Christa L
authors.initials: CL
authors.lastname: Fischer Walker
authors.forename: Hala S
authors.initials: HS
authors.lastname: Hamza
authors.forename: Adriana
authors.initials: A
authors.lastname: Vince
authors.forename: Naglaa
authors.initials: N
authors.lastname: Abdel Rahman
authors.forename: Sasa
authors.initials: S
authors.lastname: Andrasevic
authors.forename: Soha
authors.initials: S
authors.lastname: Emam
authors.forename: Dubravka
authors.initials: D
authors.lastname: Vukelic
authors.forename: Nevine
authors.initials: N
authors.lastname: Elminawi
authors.forename: Hadeer
authors.initials: H
authors.lastname: Abdel Ghafar
authors.forename: Antonia L A
authors.initials: AL
authors.lastname: da Cunha
authors.forename: Shamim
authors.initials: S
authors.lastname: Qazi
authors.forename: Dace
authors.initials: D
authors.lastname: Gardovska
authors.forename: Mark C
authors.initials: MC
authors.lastname: Steinhoff
mesh_terms: D000284:Administration, Oral; D000658:Amoxicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D017523:Croatia; D004534:Egypt; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin