Metaanalysis of short course antibiotic treatment for group a streptococcal tonsillopharyngitis

Pediatr Infect Dis J. 2005 Oct;24(10):909-17. doi: 10.1097/01.inf.0000180573.21718.36.


Objective: To compare bacterial and clinical cure rates in patients with group A streptococcal (GAS) tonsillopharyngitis treated with oral beta-lactam or macrolide antibiotics for 4-5 days versus 10-day comparators.

Methods: Medline, Embase, reference lists and abstract searches were used to identify available publications. Trials were included if there was bacteriologic confirmation of GAS tonsillopharyngitis, random assignment to antibiotic therapy for a beta-lactam or macrolide antibiotic of a shortened course versus a 10-day comparator and assessment of bacteriologic outcome using a throat culture.

Results: Twenty-two trials involving 7470 patients were included in 4 separate analyses. Trials were grouped by a short course of cephalosporins (n = 14), macrolides (other than azithromycin) (n = 6) and penicillin (n = 2). Cephalosporin trials were further grouped by the comparator, penicillin or the same cephalosporin. Short course cephalosporin treatment was superior for bacterial cure rate compared with 10 days of penicillin [odds ratio (OR), 1.47; 95% confidence interval (CI), 1.06-2.03]. For trials with short course macrolide therapy, OR = 0.79 (95% CI 0.59-1.06) neither the macrolides nor the 10-day comparators. Short course penicillin therapy was inferior in achieving bacterial cure versus 10 days of penicillin, OR = 0.29 (95% CI 0.13-0.63). Clinical cure rates mirrored bacteriologic cure rates.

Conclusion: Superior cure rates can be achieved with shortened courses of cephalosporin therapy, but 5 days is inferior to 10 days of penicillin treatment.

Publication types

  • Meta-Analysis

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / therapeutic use*
  • Cephalosporins / administration & dosage
  • Cephalosporins / therapeutic use
  • Humans
  • Macrolides / administration & dosage
  • Macrolides / therapeutic use
  • Penicillins / administration & dosage
  • Penicillins / therapeutic use
  • Pharyngitis / drug therapy*
  • Pharyngitis / microbiology
  • Randomized Controlled Trials as Topic
  • Streptococcal Infections / drug therapy
  • Streptococcus pyogenes / drug effects
  • Time Factors
  • Tonsillitis / drug therapy*
  • Tonsillitis / microbiology
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Cephalosporins
  • Macrolides
  • Penicillins