[Treatment of acute bacterial tonsillopharyngitis in pediatrics: a meta-analysis]

Pharyngo-tonsillitis represents the most common infection of the upper respiratory tract, its treatment being the most common cause for prescribing antibiotics. Efficacy, safety and compliance of cefaclor were compared with those of other antibiotics in the treatment of paediatric acute bacterial tonsillo-pharyngitis in a meta-analysis of randomized controlled trials published between 1979 and 2003. Overall, evaluations were performed on 16 studies (Medline/PubMed, keywords "Cefaclor and tonsillo-pharyngitis) which proved eligible (Jadad score > or = 1); twelve out of 16 studies were multicentre ones, only one was a double-blind study. Mostly, the comparator agent was a beta-lactam, in four cases it was a macrolide. Efficacy and safety were end-points of all studies whereas only 13 and 4 studies evaluated adverse events and compliance, respectively. The analysis was based on a 2 x 2 contingency table with classification by treatment and number of improvements/cures, side-effects, and compliance of the individual studies. The global estimate of the effective treatment was obtained with the weighted mean of the log OR (Odds Ratio) according to Mantel-Haenszel and associated confidence intervals (CI) at 95%. Chi-square test was performed. All the calculations were performed using SAS v.8. Clinical efficacy evaluation, number of improvements/cures, did not evidence a statistically significant difference among cefaclor and comparators (93.8% vs 92.3%; Odds Ratio 1.21, IC 0.95/1.48). In the cefaclor-treated patients, adverse events were observed in a statistically significant lower percentage compared to other antibiotics: 8.5% vs 15.5% (Odds Ratio 0.49, IC 0.22/0.76; P < 0.0001). Compliance was observed in a similar proportion in both the two groups, cefaclor and comparators (Cefaclor, mean 100%; comparators, mean 98.3%). The present meta-analysis proves that in the treatment of paediatric acute bacterial tonsillo-pharyngitis cefaclor exhibits a clinical efficacy equal to other antibiotics usually employed in this setting, similar compliance but superior safety.