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Different antibiotic treatments for group A streptococcal pharyngitis
Katarina Hedin1,2,3, Sarah Thorning4, Mieke L van Driel5
1Futurum - the Academy for Health and Care, Region Jönköping County, Jönköping, Sweden.
The Cochrane Database of Systematic Reviews
|November 15, 2023
Summary
Antibiotics offer limited benefits for sore throat, with penicillin remaining a viable option if treatment is necessary. Evidence suggests carbacephem may offer better symptom relief than penicillin in some cases.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Antibiotic treatment for sore throat provides only modest benefits, with effectiveness increasing for Group A beta-haemolytic streptococci (GABHS) infections.
- The optimal antibiotic choice for GABHS tonsillopharyngitis remains unclear, necessitating comparative efficacy assessments.
- This review is an update of previous analyses of antibiotic treatments for streptococcal pharyngitis.
Purpose of the Study:
- To compare the efficacy of different antibiotics in alleviating symptoms, shortening illness duration, and preventing clinical relapse and complications of GABHS tonsillopharyngitis.
- To assess the comparative incidence of adverse effects associated with various antibiotic treatments.
- To evaluate the overall risk-benefit profile of antibiotic therapy for streptococcal pharyngitis.
Main Methods:
- A systematic review and meta-analysis of randomized, double-blind trials comparing different antibiotics for GABHS tonsillopharyngitis.
- Searches included major databases (CENTRAL, MEDLINE, Embase, Web of Science) up to March 2023.
- Data extraction and risk of bias assessment followed Cochrane methodology; GRADE approach was used for evidence certainty.
Main Results:
- Uncertainty exists regarding differences in symptom resolution and clinical relapse between cephalosporins, macrolides, and penicillin.
- Low-certainty evidence suggests carbacephem may offer better symptom resolution than penicillin.
- Adverse events were more common with macrolides and azithromycin compared to penicillin and amoxicillin, respectively, in specific trials.
Conclusions:
- Antibiotics have a limited effect on GABHS tonsillopharyngitis, and penicillin remains a suitable choice when antibiotic treatment is indicated.
- Low-certainty evidence indicates carbacephem may be more effective for symptom resolution than penicillin in children.
- Further research in low-income countries is needed due to the scarcity of data on complications in at-risk populations.
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