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Updated: May 11, 2026

Antibiotic Dereplication Using the Antibiotic Resistance Platform
Published on: October 17, 2019
Different antibiotic treatments for group A streptococcal pharyngitis
Mieke L van Driel1, An I M De Sutter, Natalija Keber
1Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Australia. m.vandriel@uq.edu.au
Penicillin remains a recommended first-choice antibiotic for group A beta-haemolytic streptococci (GABHS) tonsillopharyngitis due to insufficient evidence of significant differences between antibiotics. While some antibiotics show minor benefits, penicillin is cost-effective and avoids resistance issues.
Area of Science:
- Pharmacology and Infectious Diseases
- Clinical Evidence Synthesis
- Microbial Pathogenesis
Background:
- Antibiotic treatment for sore throat offers modest benefits, with increased efficacy for group A beta-haemolytic streptococci (GABHS) infections.
- Optimal antibiotic selection for GABHS tonsillopharyngitis remains unclear, necessitating comparative efficacy assessments.
Purpose of the Study:
- To compare the efficacy of various antibiotics in alleviating symptoms, shortening illness duration, and preventing relapse and complications of streptococcal pharyngitis.
- To evaluate comparative adverse effects and the overall risk-benefit profile of antibiotic therapy for GABHS tonsillopharyngitis.
Main Methods:
- A systematic review of randomized, double-blind trials was conducted, searching CENTRAL, MEDLINE, EMBASE, and Web of Science databases.
- Trials comparing different antibiotics for GABHS tonsillopharyngitis, reporting clinical cure, relapse, complications, or adverse events, were included.
- Data extraction and trial screening were performed independently by two authors.
Main Results:
- Seventeen trials involving 5352 participants were analyzed, primarily comparing penicillin with cephalosporins, macrolides, and carbacephems.
- No significant difference in symptom resolution was found between cephalosporins and penicillin.
- Cephalosporins demonstrated a lower rate of clinical relapse in adults, while carbacephems showed improved symptom resolution in children; macrolides were associated with more adverse events in children.
Conclusions:
- Insufficient evidence exists to support clinically significant differences among antibiotics for GABHS tonsillopharyngitis.
- Limited data suggest potential benefits of cephalosporins for relapse in adults and carbacephems for symptom resolution in children, but with high numbers needed to treat.
- Considering cost-effectiveness and resistance patterns, penicillin is recommended as the first-line treatment for GABHS tonsillopharyngitis.
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