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Azithromycin versus penicillin V for treatment of acute group A streptococcal pharyngitis
Urs B Schaad1, Patricia Kellerhals, Martin Altwegg
1University Children's Hospital of Basel, Zurich, Switzerland. urs-b.schaad@unibas.ch
Insights
A 3-day azithromycin course for group A streptococcal (GAS) pharyngitis showed similar clinical success to 10-day penicillin V but had significantly lower bacteriologic eradication rates in children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Acute group A streptococcal (GAS) pharyngitis is a common childhood infection.
- Penicillin V has been the standard treatment, but concerns about adherence and resistance exist.
- Azithromycin offers a shorter treatment course, potentially improving compliance.
Purpose of the Study:
- To compare the clinical and bacteriologic efficacy of a 3-day azithromycin regimen versus a 10-day penicillin V regimen for treating acute GAS pharyngitis in children.
- To investigate the impact of viral infections and GAS carriage on treatment outcomes.
Main Methods:
- A multicenter, randomized, open-label study compared 10 mg/kg/day azithromycin for 3 days with 100,000 IU/kg/day penicillin V for 10 days in children with GAS pharyngitis.
- Clinical and bacteriologic outcomes, as well as tolerability, were assessed.
- Patients were monitored for symptom recurrence for 6 months.
Main Results:
- Clinical cure/improvement rates were similar for both azithromycin (95%) and penicillin V (97%) at Day 14, and (94% vs. 95%) at Day 28.
- Bacteriologic eradication was significantly lower with azithromycin (38% at Day 14, 31% at Day 28) compared to penicillin V (81% at Day 14, 68% at Day 28).
- Both treatments were well-tolerated, with no increase in GAS-related sequelae.
Conclusions:
- A 3-day azithromycin regimen achieves similar clinical efficacy to a 10-day penicillin V regimen for GAS pharyngitis in children.
- However, azithromycin is associated with significantly lower bacteriologic eradication rates.
- The choice of antibiotic should consider both clinical outcomes and bacteriologic eradication potential.
Objective:
To compare a 3-day azithromycin vs. a 10-day penicillin V regimen for treatment of acute group A streptococcal (GAS) pharyngitis in children and to determine whether viral infection and/or pharyngeal GAS carriage in patients and adult contacts affect clinical and bacteriologic efficacy.
Methods:
This multicenter, randomized, comparative, open label study compared 3-day, once daily 10 mg/kg azithromycin oral suspension with a 10-day regimen of 100,000 IU/kg/day penicillin V oral suspension in three divided doses in children with acute GAS pharyngitis. Clinical and bacteriologic efficacy and tolerability of the antibiotics were evaluated. Recurrence of symptoms and infection was monitored for 6 months.
Results:
In total, 292 children (age range, 2 to 12 years) received at least one dose of study medication. Clinical success (cure/improvement) with either antibiotic was similar at the end of therapy (Day 14; azithromycin, 95%; penicillin V, 97%) and at Day 28 (azithromycin, 94%; penicillin V, 95%). Bacteriologic eradication was significantly less with azithromycin than with penicillin V at Day 14 (azithromycin, 38%; penicillin V, 81%; P < 0.001) and at Day 28 (azithromycin, 31%; penicillin V, 68%; P < 0.001). There was no associated increase in GAS-related sequelae. The lower incidence of bacteriologic eradication with azithromycin was not the result of possible concomitant viral infections in the patients, GAS carriage in one parent/guardian or any reduced susceptibility in pretreatment GAS isolates. Both antibiotics were equally well-tolerated.
Conclusions:
Treatment with 3-day, once daily 10 mg/kg azithromycin for GAS pharyngitis is associated with similar high levels of clinical efficacy, but lower levels of bacteriologic eradication, than with 10-day 100,000 IU/kg/day penicillin V.