Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children.
BACKGROUND
The standard duration of treatment for children with acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral penicillin is 10 days. Shorter duration antibiotics may have comparable efficacy.


OBJECTIVE
To summarize the evidence regarding the efficacy of two to six days of newer oral antibiotics (short duration) compared to 10 days of oral penicillin (standard duration) in treating children with acute GABHS pharyngitis.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 3) which contains the Cochrane Acute Respiratory Infections Group's Specialized Register, MEDLINE (January 1966 to March week 3, 2012) and EMBASE (January 1990 to April 2012).


METHODS
Randomized controlled trials (RCTs) comparing short duration oral antibiotics to standard duration oral penicillin in children aged 1 to 18 years with acute GABHS pharyngitis.


METHODS
Two review authors scanned the titles and abstracts of retrieved citations and applied the inclusion criteria. We retrieved included studies in full, and extracted data. Two review authors independently assessed trial quality.


RESULTS
We included 20 studies with 13,102 cases of acute GABHS pharyngitis. The updated search did not identify any new eligible studies; the majority of studies were at high risk of bias. However, the majority of the results were consistent. Compared to standard duration treatment, the short duration treatment studies had shorter periods of fever (mean difference (MD) -0.30 days, 95% confidence interval (CI) -0.45 to -0.14) and throat soreness (MD -0.50 days, 95% CI -0.78 to -0.22); lower risk of early clinical treatment failure (odds ratio (OR) 0.80, 95% CI 0.67 to 0.94); no significant difference in early bacteriological treatment failure (OR 1.08, 95% CI 0.97 to 1.20) or late clinical recurrence (OR 0.95, 95% CI 0.83 to 1.08). However, the overall risk of late bacteriological recurrence was worse in the short duration treatment studies (OR 1.31, 95% CI 1.16 to 1.48), although no significant differences were found when studies of low dose azithromycin (10 mg/kg) were eliminated (OR 1.06, 95% CI 0.92 to 1.22). Three studies reported long duration complications. Out of 8135 cases of acute GABHS pharyngitis, only six cases in the short duration treatment versus eight in the standard duration treatment developed long-term complications in the form of glomerulonephritis and acute rheumatic fever, with no statistically significant difference (OR 0.53, 95% CI 0.17 to 1.64).


CONCLUSIONS
Three to six days of oral antibiotics had comparable efficacy compared to the standard duration 10-day course of oral penicillin in treating children with acute GABHS pharyngitis. . In areas where the prevalence of rheumatic heart disease is still high, our results must be interpreted with caution.
Department of Emergency Medicine and Pediatrics, King Fahad Medical City, Riyadh, Saudi Arabia. saltamimi@kfmc.med.sa
Saleh
S
Altamimi
Adli
A
Khalil
Khalid A
KA
Khalaiwi
Ruth A
RA
Milner
Martin V
MV
Pusic
Mohammed A
MA
Al Othman
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D006801:Humans; D007223:Infant; D010406:Penicillins / Q000008:administration & dosage*; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D013297:Streptococcus pyogenes; D014069:Tonsillitis / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents; D010406:Penicillins; D017963:Azithromycin