Two dosages of clarithromycin for five days, amoxicillin/clavulanate for five days or penicillin V for ten days in acute group A streptococcal tonsillopharyngitis

Pediatr Infect Dis J. 2004 Sep;23(9):857-65. doi: 10.1097/01.inf.0000138080.74674.a2.

Abstract

Background: Short course antimicrobial therapy is suggested for group A streptococcal tonsillopharyngitis.

Methods: The bacteriologic and clinical efficacies of clarithromycin [30 or 15 mg/kg/day twice daily (b.i.d.)] or amoxicillin/clavulanate (43.8/6.2 mg/kg/day b.i.d.) for 5 days or penicillin V (30 mg/kg/day 3 times a day) for 10 days were compared. In a randomized, open label, parallel group, multicenter study, 626 children (2-16 years old) with tonsillopharyngitis were enrolled; 537 were evaluable for efficacy. Follow-up evaluations were performed at 4-8 and 21-28 days after therapy.

Results: At enrollment, 26% of the Streptococcus pyogenes isolates were clarithromycin-nonsusceptible. All regimens had an apparently similar clinical efficacy. The long term S. pyogenes eradication rates were 102 of 123 (83%) with amoxicillin/clavulanate and 88 of 114 (77%) with penicillin V. In the 30- and 15-mg/kg/day clarithromycin groups, eradication occurred in 71 of 86 (83%) and 59 of 80 (74%) of the clarithromycin-susceptible isolates (P = 0.33), and in 4 of 28 (14%) and 5 of 26 (19%) of the clarithromycin-resistant isolates, respectively (clarithromycin-susceptible versus -resistant, P < 0.0001). Both clarithromycin dosages were well-tolerated.

Conclusions: In group A streptococcal tonsillopharyngitis, 5 days of clarithromycin or amoxicillin/clavulanate treatment had clinical efficacy comparable with that of 10 days of penicillin V treatment; however, amoxicillin/clavulanate and penicillin V were bacteriologically more effective than clarithromycin because of its failure to eradicate the clarithromycin-resistant S. pyogenes isolates. The 5-day clarithromycin regimens are not recommended for treatment of streptococcal tonsillopharyngitis in areas where in vitro resistance of group A streptococci to clarithromycin is common.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Amoxicillin-Potassium Clavulanate Combination / administration & dosage*
  • Child
  • Child, Preschool
  • Clarithromycin / administration & dosage*
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Penicillin V / administration & dosage*
  • Pharyngitis / drug therapy*
  • Pharyngitis / microbiology
  • Probability
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / drug therapy*
  • Streptococcus pyogenes / drug effects
  • Streptococcus pyogenes / isolation & purification
  • Tonsillitis / drug therapy*
  • Tonsillitis / microbiology
  • Treatment Outcome

Substances

  • Amoxicillin-Potassium Clavulanate Combination
  • Clarithromycin
  • Penicillin V