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Macrolides in the management of streptococcal pharyngitis/tonsillitis
1Department of Pediatrics, Birmingham Heartlands Hospital, Bordesley Green East, UK.
Insights
Group A Streptococcus causes common childhood throat infections. Newer macrolide antibiotics like azithromycin offer convenient dosing and fewer side effects than erythromycin for treating strep throat, especially in penicillin-allergic children.
Area of Science:
- Infectious Diseases
- Pediatrics
- Pharmacology
Background:
- Group A beta-hemolytic streptococci are the primary bacterial cause of pediatric pharyngitis/tonsillitis.
- Preventing acute rheumatic fever is the main objective of treatment.
- Antibiotic therapy aids in symptom relief, shortens infection duration, and prevents complications.
Purpose of the Study:
- To evaluate newer macrolides as alternatives for treating streptococcal pharyngitis/tonsillitis.
- To compare the efficacy and tolerability of clarithromycin and azithromycin with erythromycin and penicillin.
Main Methods:
- Review of current treatment guidelines and clinical data for streptococcal pharyngitis.
- Comparison of dosing regimens, side effect profiles, and treatment durations of various antibiotics.
- Focus on penicillin-allergic patients and bacteriologic failure rates.
Main Results:
- Penicillin remains the drug of choice, but alternatives are needed due to potential bacteriologic failure and allergies.
- Erythromycin use is limited by frequent dosing, long treatment duration, and gastrointestinal side effects.
- Newer macrolides, clarithromycin (twice daily) and azithromycin (once daily), show improved tolerability and convenience.
- Azithromycin's 5-day course is shorter than the 10-day regimens for other antibiotics.
Conclusions:
- Newer macrolides, clarithromycin and azithromycin, are effective and well-tolerated alternatives to erythromycin for streptococcal pharyngitis.
- Azithromycin offers a convenient once-daily, 5-day treatment option for pediatric patients.
- These macrolides provide rational therapeutic choices for penicillin-allergic individuals requiring treatment for strep throat.
Abstract:
The most frequent bacterial cause of pharyngitis/tonsillitis, a common infection in children, is group A beta-hemolytic streptococci. Prevention of acute rheumatic fever is the principal goal of treatment, although antibiotic therapy may also relieve the signs and symptoms of infection, shorten the infective period and prevent suppurative complications. Penicillin is the drug of choice. Alternatives are required, however, for patients allergic to penicillin and may be needed if the rate of bacteriologic failure with penicillin observed during the past decade continues. Erythromycin is generally effective in this infection, but its use, especially in children, is complicated by the need for multiple daily doses, a lengthy treatment period and a high rate of gastrointestinal side effects. The newer macrolides clarithromycin and azithromycin offer lower rates of gastrointestinal complaints and more convenient dosing. Clarithromycin is recommended for twice daily and azithromycin for once daily administration. Because of its prolonged tissue half-life, the recommended duration of azithromycin therapy is 5 days, compared with 10 days for penicillin, erythromycin and clarithromycin. Newer macrolides are rational alternatives to erythromycin for streptococcal pharyngitis/tonsillitis in penicillin-allergic patients.