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Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children

Saleh Altamimi1, Adli Khalil, Khalid A Khalaiwi

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

The Cochrane Database of Systematic Reviews
|August 17, 2012
PubMed

Insights

Shorter antibiotic courses (3-6 days) are as effective as 10-day penicillin for acute group A beta hemolytic streptococcus (GABHS) pharyngitis in children. This approach offers comparable efficacy with potential benefits in symptom duration and early treatment failure.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Clinical Efficacy Trials

Background:

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

Purpose of the Study:

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

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched Cochrane CENTRAL, MEDLINE, and EMBASE databases for relevant studies.
  • Included RCTs comparing short-duration oral antibiotics to standard-duration oral penicillin in children aged 1-18 years with acute GABHS pharyngitis.

Main Results:

  • Twenty studies involving 13,102 children were included; most studies had a high risk of bias.
  • Short-duration treatment was associated with shorter fever duration and throat soreness, and a lower risk of early clinical treatment failure.
  • No significant difference in early bacteriological failure or late clinical recurrence was observed, but late bacteriological recurrence was higher overall (though not significant when low-dose azithromycin was excluded). Long-term complications showed no statistically significant difference between groups.

Conclusions:

  • Short-duration oral antibiotic courses (3-6 days) demonstrate comparable efficacy to the standard 10-day penicillin regimen for acute GABHS pharyngitis in children.
  • These findings support the use of shorter antibiotic durations, potentially improving adherence and reducing side effects.
  • Caution is advised when interpreting results in regions with a high prevalence of rheumatic heart disease.
Abstract

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