Drug choice for treatment of streptococcal pharyngitis - Tips from Other Journals

Date: Sept, 1991

For the past four decades, penicillin has been the drug of choice for the treatment of group A beta-hemolytic streptococcal pharyngitis. However, treatment with penicillin alone fails in up to 30 percent of infections. Some authorities are concerned that these treatment failures may contribute to the recent increase in the incidence of acute rheumatic fever. Pichichero and Margolis undertook a meta-analysis of 19 studies that compared penicillin with cephalosporins in the treatment of streptococcal pharyngitis.

The studies spanned 20 years and involved numerous investigators in a variety of clinical settings. When the results of all of the studies were combined, the overall bacteriologic cure rate was 84 percent for patients treated with penicillin, compared with 92 percent for those treated with cephalosporins. The overall clinical cure rate was 89 percent for penicillin, compared with 95 percent for cephalosporins. Variations in compliance were not believed to explain the differences in these rates, and intramuscular administration did not enhance efficacy.

Although the differences in cure rates are statistically significant, they are small, and most patients were cured by either therapy. The results of the analysis suggested that 12 to 13 patients would need to be treated with cephalosporins to prevent one penicillin-associated bacteriologic treatment failure, while 16 to 17 patients would need to be treated with cephalosporins to prevent one penicillin-associated clinical failure.

Penicillin remains the drug of choice for group A beta-hemolytic streptococcal infections. However, if patients fail to respond to penicillin or continue to become reinfected after therapy with penicillin, treatment with an alternative agent, such as a cephalosporin, may be appropriate. (Pediatric Infectious Disease Journal, April 1991, vol. 10, p. 275.)

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