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Immediate vs. delayed treatment of group A beta-hemolytic streptococcal pharyngitis with penicillin V
N T el-Daher1, S S Hijazi, N M Rawashdeh
1Department of Microbiology and Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid.
Insights
Early penicillin V treatment for Group A streptococcal pharyngitis reduces symptoms and antibody response. However, delayed treatment may lower the incidence of recurrent streptococcal pharyngitis in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Group A beta-hemolytic streptococcal (Group A Strep) pharyngitis is a common childhood infection.
- Penicillin V is the standard treatment, but optimal timing is debated.
Purpose of the Study:
- To compare the clinical outcomes of immediate versus delayed penicillin V treatment for Group A Strep pharyngitis in children.
- To assess the impact of treatment timing on symptom severity, antibody response, and recurrence rates.
Main Methods:
- A randomized, double-blind trial involving 306 children with probable Group A Strep pharyngitis.
- Patients were assigned to immediate penicillin V or a 48-52 hour placebo followed by penicillin V.
- Clinical evaluations and Streptozyme antibody titers were used to assess outcomes.
Main Results:
- Both immediate and delayed treatment achieved >92% cure rates.
- Immediate treatment led to milder Day 3 symptoms and lower antibody titers.
- Delayed treatment was associated with significantly fewer relapses and recurrences of Group A Strep pharyngitis.
Conclusions:
- Early penicillin V administration benefits the acute clinical course of streptococcal pharyngitis.
- Delayed penicillin V treatment may reduce the incidence of subsequent Group A Strep pharyngitis episodes.
Abstract:
Three hundred six children with probable Group A beta-hemolytic streptococcal pharyngitis were enrolled in a randomized double blind trial to compare the effects of immediate vs. delayed treatment with oral penicillin V. Among the 229 culture-positive patients, 111 were randomly assigned to receive penicillin V immediately and 118 to receive a placebo for 48 to 52 hours followed by penicillin V. Patients were evaluated clinically for 48 to 52 hours following initiation of treatment. The Streptozyme test was used to measure acute to convalescent antibody titer. Both regimens resulted in a greater than 92% cure rate. Early treatment was associated with significantly fewer and milder signs and symptoms on Day 3 and a significantly lower rise in the antibody titer. On the other hand we found 8 (7%) relapses and 18 (16%) early and 14 (13%) late recurrences in this group; all were significantly higher than the corresponding numbers of 2 (2%), 6 (5%) and 4 (3%), respectively, in the late treatment group. This study shows the beneficial effect of early treatment with penicillin V on the clinical course of Group A beta-hemolytic streptococcal pharyngitis. This study also shows that delayed penicillin treatment may be associated with a lower incidence of subsequent Group A beta-hemolytic streptococcal pharyngitis.