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Pharyngitis/tonsillitis: European and United States experience with cefpodoxime proxetil
1Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
Abstract:
Most authorities continue to recommend penicillin as the treatment of choice for group A streptococcal pharyngitis. If penicillin is used, 10 days of treatment are necessary to achieve a clinical and bacteriologic cure. The usually recommended penicillin V dose is 250 mg (400,000 IU) three times daily. Twice daily dosing is acceptable to some authorities if compliance is good. However, oral penicillin fails to eradicate group A streptococci from the pharynx in up to 17% of cases; in some studies 30% failure rates have been reported. Several European and United States studies indicate that a variety of oral cephalosporins, when used for 10 days, are significantly superior to penicillin V in eradicating group A streptococci from the pharynx. For example cefpodoxime proxetil given twice daily for 10 days is comparable to penicillin V given three times daily for 10 days in achieving a clinical cure and appears to be significantly superior to penicillin in eradicating group A streptococci from the pharynx. Preliminary studies from Europe and the United States strongly suggest that 5-day therapy with cefpodoxime (or other selected oral cephalosporins) is at least as effective, clinically and microbiologically, as 10-day therapy with penicillin V. Further clinical trials are warranted to confirm the adequacy of 5-day treatment and to assess the efficacy of cefpodoxime and other agents in preventing rheumatic fever.
Insights
Penicillin is recommended for strep throat, but often fails to eradicate bacteria. Newer cephalosporins, like cefpodoxime, show promise for shorter, more effective treatment regimens.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Group A streptococcal pharyngitis is commonly treated with penicillin.
- Standard penicillin V therapy requires 10 days for clinical and bacteriologic cure.
- Penicillin V has notable failure rates in eradicating Streptococcus pyogenes from the pharynx, with reported failures up to 30%.
Purpose of the Study:
- To evaluate the efficacy of oral cephalosporins compared to penicillin V for treating group A streptococcal pharyngitis.
- To investigate shorter treatment durations for cephalosporin therapy.
Main Methods:
- Comparative studies analyzing clinical and bacteriologic cure rates.
- Evaluation of different treatment durations (10-day vs. 5-day) and dosing frequencies.
- Assessment of Streptococcus pyogenes eradication from the pharynx.
Main Results:
- Oral cephalosporins demonstrate superior eradication rates of Streptococcus pyogenes compared to penicillin V.
- Cefpodoxime proxetil, given for 10 days, shows comparable clinical cure rates to penicillin V but improved bacterial eradication.
- Preliminary data suggest 5-day cefpodoxime therapy is as effective as 10-day penicillin V therapy.
Conclusions:
- Oral cephalosporins, including cefpodoxime, offer advantages over penicillin V in eradicating group A Streptococcus.
- Shorter treatment durations (5 days) with certain cephalosporins may be as effective as longer penicillin courses.
- Further research is needed to confirm 5-day cephalosporin efficacy and their role in preventing rheumatic fever.