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Randomized, comparative efficacy trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in
Susanne Navarini Meury1, Thomas Erb, Urs B Schaad
1Division of Pediatric Infectious Diseases, University Children's Hospital Basel, Basel, Switzerland.
Insights
Cefuroxime demonstrated superior efficacy over penicillin in treating group A beta-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis in children. Cefuroxime is recommended as the preferred treatment for this condition.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Microbiology
Background:
- Perianal dermatitis in children can be caused by Group A beta-hemolytic Streptococcus pyogenes (GABHS).
- Standard treatment protocols require evaluation for optimal antibiotic selection.
Purpose of the Study:
- To compare the effectiveness of penicillin versus cefuroxime for treating GABHS perianal dermatitis in pediatric patients.
- To determine the preferred antibiotic for GABHS-related perianal infections.
Main Methods:
- A randomized controlled trial involving children aged 1 to 16 years with confirmed GABHS perianal dermatitis.
- Patients received either penicillin or cefuroxime, with clinical assessments and anal swabs performed at specified intervals.
- Disease severity was quantified using a standardized clinical scoring system.
Main Results:
- The study was terminated early due to the clear superiority of cefuroxime over penicillin.
- Patients treated with cefuroxime showed significantly faster clinical improvement (P = .028).
- GABHS eradication was achieved in 13/14 patients on cefuroxime versus 7/15 on penicillin (P < .01).
Conclusions:
- Cefuroxime is more effective than penicillin for treating GABHS perianal dermatitis.
- Cefuroxime should be considered the treatment of choice for this pediatric condition.
Objective:
To investigate the efficacy of penicillin compared with cefuroxime for group A beta-hemolytic Streptococcus pyogenes (GABHS) perianal dermatitis.
Study Design:
Children 1 to 16 years of age with signs and symptoms of perianal dermatitis and a positive anal swab were randomized to penicillin or cefuroxime treatment and were clinically re-evaluated on day 3 and at the end of treatment (cefuroxime, day 7; penicillin, day 10). An anal swab was obtained to document eradication of GABHS at the end of treatment. Severity of disease was assessed with a clinical score (perianal erythema, 5 points; perianal itch, 3 points; painful defecation, 3 points; constipation, 2 points).
Results:
Patients were enrolled and randomly assigned to penicillin (n = 18) or cefuroxime (n = 17) treatment. Treatment with penicillin was inferior to cefuroxime, which led to premature study termination after consultation with the ethics committee. Clinical improvement was more rapid in the cefuroxime group (P = .028) and GAHBS was not isolated from the anus the last day of therapy in 13 of 14 patients treated with cefuroxime compared with 7 of 15 patients treated with penicillin (P < .01).
Conclusions:
Cefuroxime was more effective than penicillin and therefore should be considered as the treatment of choice for perianal dermatitis due to GABHS.
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