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Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children

Saleh Altamimi1, Adli Khalil, Khalid A Khalaiwi

  • 1Department of Emergency Medicine and Pediatrics, King Fahd Medical City, Riyadh, Saudi Arabia, 11563. saltamimi@kfmc.med.sa

The Cochrane Database of Systematic Reviews
|January 23, 2009
PubMed

Insights

Short-duration antibiotics (3-6 days) are as effective as 10-day penicillin for treating group A beta-hemolytic streptococcus (GABHS) pharyngitis in children. This approach is safe in low-rheumatic fever regions but requires caution where rheumatic heart disease is prevalent.

Area of Science:

  • Pediatric infectious diseases
  • Pharmacology and therapeutics
  • Evidence-based medicine

Background:

  • The standard treatment for acute group A beta-hemolytic streptococcus (GABHS) pharyngitis involves a 10-day course of oral penicillin.
  • Emerging evidence suggests that shorter antibiotic durations may offer comparable efficacy.

Purpose of the Study:

  • To evaluate the efficacy of short-duration oral antibiotics (2-6 days) versus standard 10-day oral penicillin for treating GABHS pharyngitis in children.
  • To compare clinical and bacteriological outcomes between short and standard antibiotic durations.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
  • Searches included major databases like CENTRAL, DARE, MEDLINE, OLDMEDLINE, and EMBASE up to November 2007.
  • Twenty RCTs involving 13,102 children aged 1 to 18 years were included.

Main Results:

  • Short-duration treatment led to reduced fever and sore throat duration compared to standard treatment.
  • Early clinical treatment failure was lower with short-duration antibiotics, with no significant difference in early bacteriological failure or late clinical recurrence.
  • A higher risk of late bacteriological recurrence was observed with short-duration treatment, particularly with low-dose azithromycin, but this was not significant when these studies were excluded.
  • No statistically significant difference in long-term complications was reported.

Conclusions:

  • Short-duration oral antibiotics (3-6 days) demonstrate comparable efficacy to 10-day penicillin for GABHS pharyngitis in children.
  • The use of short-duration antibiotics appears safe and effective in regions with low rates of rheumatic fever.
  • Caution is advised when interpreting these findings in areas with a high prevalence of rheumatic heart disease.
Abstract

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