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Streptococcal pharyngitis therapy: comparison of clindamycin palmitate and potassium phenoxymethyl penicillin
Insights
Clindamycin palmitate and penicillin were equally effective against streptococcal pharyngitis in children. However, penicillin is preferred due to clindamycin
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
- Microbiology
Background:
- Group A streptococcal pharyngitis is a common childhood illness.
- Antibiotic treatment is crucial for preventing complications.
Purpose of the Study:
- To compare the efficacy and safety of clindamycin palmitate and potassium phenoxymethyl penicillin in treating pediatric upper respiratory infections caused by group A streptococci.
Main Methods:
- A randomized trial involving 103 children with confirmed group A streptococcal pharyngitis.
- Oral administration of clindamycin palmitate or potassium phenoxymethyl penicillin for 10 days, with weight-based dosing.
- Treatment failure defined as recurrence of original streptococcal types within 3 weeks post-treatment.
Main Results:
- Clindamycin palmitate showed a lower failure rate (10%) compared to potassium phenoxymethyl penicillin (18%).
- Drug-related rashes were observed in 8% of patients treated with clindamycin palmitate.
- Both antibiotics demonstrated effective eradication of group A streptococci from the pharynx.
Conclusions:
- Clindamycin palmitate and potassium phenoxymethyl penicillin exhibit comparable efficacy in treating streptococcal pharyngitis.
- Penicillin is recommended over clindamycin palmitate due to a higher incidence of rash and increased cost associated with clindamycin.
Abstract:
Clindamycin palmitate and potassium phenoxymethyl penicillin were evaluated in 103 children with upper respiratory illnesses and pharyngeal group A streptococci, from November 1970 to July 1971. The children were assigned randomly by weight to one of the antibiotic regimens given orally for 10 days. Clindamycin palmitate and potassium phenoxymethyl penicillin dosages were 75 and 125 mg, respectively, in 5 ml tid for children weighing less than 25 kg, and 150 and 250 mg, respectively, in 10 ml bid for children weighing 25 kg or more. Recurrences of the original streptococcal group A, M, and T types within 3 weeks after the end of treatment were classified as failures. The failure rates were: clindamycin palmitate, 10% (5 of 52), and potassium phenoxymethyl penicillin, 18% (9 of 51). Possible drug-related rashes were observed in 8 of 52 clindamycin palmitate-treated patients. The geometric mean minimal inhibitory concentrations of clindamycin and penicillin against 103 isolates of group A streptococci were 0.033 and 0.007 mug/ml, respectively. The serum concentrations about 70 min after ingesting 150 mg of clindamycin palmitate averaged 3.8 mug/ml and after 250 mg of potassium phenoxymethyl penicillin averaged 0.9 mug/ml. Clindamycin palmitate was as effective as potassium phenoxymethyl penicillin in eradicating group A streptococci from the pharynx in tid and bid regimens. Nevertheless, because of its rash-producing tendency in some patients and higher cost, clindamycin palmitate should not be preferred to penicillin for treatment of streptococcal sore throat in the non-penicillin-allergic patient.