Optimum treatment of streptococcal pharyngitis
F Scaglione1, G Demartini, M M Arcidiacono
1Department of Pharmacology, University of Milan, Italy.
Insights
Penicillin and cephalosporin antibiotics are recommended for treating group A streptococcal pharyngitis in children and adolescents. These treatments are effective, though cephalosporins may be preferred for recurrent infections.
Area of Science:
- Infectious Diseases
- Pediatrics
- Pharmacology
Background:
- Group A beta-hemolytic streptococci cause most cases of streptococcal pharyngitis in children and adolescents.
- While penicillin has reduced rheumatic fever, recent studies show increasing penicillin treatment failures.
- Erythromycin, an alternative for penicillin-allergic patients, has reported failure rates up to 24.7% and increasing resistance.
Purpose of the Study:
- To evaluate the efficacy of different antibiotic treatments for streptococcal pharyngitis.
- To compare the clinical failure rates of penicillins, cephalosporins, and erythromycin.
- To provide evidence-based recommendations for first-line antibiotic therapy.
Main Methods:
- Literature review of studies on pharyngitis treatment.
- Analysis of clinical failure rates associated with different antibiotic classes.
- Assessment of resistance patterns and adverse effect profiles.
Main Results:
- Penicillin treatment failures have been reported with increasing frequency.
- Cephalosporins demonstrate a lower rate of clinical failure compared to penicillins.
- Erythromycin exhibits significant resistance and high failure rates in treating pharyngitis.
Conclusions:
- Oral penicillins and cephalosporins should be considered first-line agents for culture-confirmed group A streptococcal tonsillopharyngitis.
- Cephalosporins are particularly useful for managing recurrent streptococcal tonsillopharyngitis.
- Antibiotic stewardship is crucial given increasing resistance and treatment failures.
Abstract:
Streptococcal pharyngitis is a common infection in children and adolescents. The great majority of these infections are caused by group A beta-haemolytic streptococci. Although the use of penicillins for group A beta-haemolytic streptococcal pharyngitis has reduced the incidence of rheumatic fever, in the past decade several studies of pharyngitis treatment have reported penicillin failure. It has also been suggested that in comparison with the penicillins the cephalosporins are associated with a lower rate of clinical failure. Cephalosporins have drawbacks in cost, administration frequency or adverse effect profile. Moreover, there is the theoretical risk of cross-antigenicity to cephalosporins in penicillin-allergic patients. Erythromycin is a traditional alternative to penicillins, especially in penicillin-allergic patients, for the treatment of tonsillopharyngitis. However, increased resistance as well as failure rates as high as 24.7% have been reported for erythromycin in the treatment of pharyngitis. Therefore oral penicillins, and alternatively oral cephalosporins, should be considered first-line agents for the treatment of culture-confirmed group A beta-haemolytic streptococcal tonsillopharyngitis. Cephalosporins are useful especially for the treatment of recurrent streptococcal tonsillopharyngitis.
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