Clinical Citations: Comparing the efficacy of antibiotics in the treatment of group A strep throat

The Journal of Respiratory Diseases Vol 6 No 1, Volume 6, Issue 1

Although penicillin has been the antibiotic of choice for group A streptococcal (GAS) tonsillopharyngitis, a number of other antibiotics are used as well. This includes azithromycin, which may be preferred by some because of its dosing schedule. The results of a meta-analysis by Casey and Pichichero indicate that a total treatment dose of 60 mg/kg of azithromycin is necessary to eradicate GAS tonsillopharyngitis in children, and this regimen appears to be more effective than regimens of other antibiotics studied.

Although penicillin has been the antibiotic of choice for group A streptococcal (GAS) tonsillopharyngitis, a number of other antibiotics are used as well. This includes azithromycin, which may be preferred by some because of its dosing schedule. The results of a meta-analysis by Casey and Pichichero indicate that a total treatment dose of 60 mg/kg of azithromycin is necessary to eradicate GAS tonsillopharyngitis in children, and this regimen appears to be more effective than regimens of other antibiotics studied.

The meta-analysis included 19 randomized controlled trials involving 4626 patients. The trials compared 1 or 2 azithromycin regimens with 1 or 2 comparator antibiotics administered for 10 days (Table).

Bacterial failure was 5 times more likely to occur in children who received the 10-day courses of comparator antibiotics than in those who received 60 mg/kg of azithromycin. The rate of bacterial failure was 3 times higher in those who received 30 mg/kg of azithromycin than in those who received comparator antibiotics. The 3-day regimens were shown to be inferior to the 5-day regimens.

In adults, the difference between azithromycin and the comparator antibiotics was not statistically significant, but there was a trend favoring azithromycin (P = .14). In contrast to the finding in children, the 3-day regimens were superior to 5-day regimens.

The differences in clinical cure rates resembled those for bacterial cure rates.