title: Different antibiotic treatments for group A streptococcal pharyngitis.
abstract: BACKGROUND
  Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated.
  
  
  OBJECTIVE
  To assess the evidence on the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing relapse; and (d) preventing complications (suppurative complications, acute rheumatic fever, post-streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk-benefit of antibiotic treatment for streptococcal pharyngitis.
  
  
  METHODS
  We searched CENTRAL 2012, Issue 10, MEDLINE (1966 to October week 2, 2012), EMBASE (1974 to October 2012) and Web of Science (2010 to October 2012).
  
  
  METHODS
  Randomised, double-blind trials comparing different antibiotics and reporting at least one of the following: clinical cure, clinical relapse, complications, adverse events.
  
  
  METHODS
  Two authors independently screened trials for inclusion and extracted data.
  
  
  RESULTS
  Seventeen trials (5352 participants) were included; 16 compared with penicillin (six with cephalosporins, six with macrolides, three with carbacephem and one with sulfonamides), one trial compared clindamycin and ampicillin. Randomisation reporting, allocation concealment and blinding were poor.There was no difference in symptom resolution between cephalosporins and penicillin (intention-to-treat (ITT) analysis; N = 5; n = 2018; odds ratio for absence of resolution of symptoms (OR) 0.79, 95% confidence interval (CI) 0.55 to 1.12). Clinical relapse was lower with cephalosporins (N = 4; n = 1386; OR 0.55, 95% CI 0.31 to 0.99; overall number needed to treat to benefit (NNTB) 50), but found only in adults (OR 0.42, 95% CI 0.20 to 0.88; NNTB 33). There were no differences between macrolides and penicillin. Carbacephem showed better symptom resolution post-treatment (N = 3; n = 795; OR 0.70, 95% CI 0.49 to 0.99; NNTB 14), but only in children (N = 2; n = 233; OR 0.57, 95% CI 0.33 to 0.99; NNTB 8.3). Children experienced more adverse events with macrolides (N = 1, n = 489; OR 2.33; 95% CI 1.06 to 5.15).
  
  
  CONCLUSIONS
  Evidence is insufficient to show clinically meaningful differences between antibiotics for GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be recommended as first choice.
authors: Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Australia. m.vandriel@uq.edu.au
authors: Mieke L
authors: ML
authors: van Driel
authors: An I M
authors: AI
authors: De Sutter
authors: Natalija
authors: N
authors: Keber
authors: Hilde
authors: H
authors: Habraken
authors: Thierry
authors: T
authors: Christiaens
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002981:Clindamycin / Q000627:therapeutic use; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013297:Streptococcus pyogenes; D013449:Sulfonamides / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018942:Macrolides; D010406:Penicillins; D013449:Sulfonamides; D002981:Clindamycin; D000667:Ampicillin