Abstract
BackgroundCulture tests have demonstrated that once-daily administration of amoxicillin may be effective in the treatment of group A streptococcal (GAS) pharyngitis. However, culture methods do not allow accurate assessments of bacterial load changes because of the suppressive effect of the antibiotic on bacterial growth. In this study, we used real-time PCR to compare the effectiveness of once-daily and multiple-daily amoxicillin treatment for pediatric patients with GAS pharyngitis.MethodsThe subjects were children (≧3 years of age) diagnosed with GAS pharyngitis. Amoxicillin was administered at a dose of 40–50 mg/kg/day, divided into one (QD), two (BID), or three (TID) daily doses, for 10 days. Throat swabs were collected before treatment (visit 1), 1 to 3 days after treatment (visit 2), and 9 to 11 days after treatment (visit 3), and GAS copies were quantified by real-time PCR. The main compared parameters were the rate of negative PCR results and the number of GAS determined by PCR in throat swabs between each regimen.ResultsSamples were collected from 34 patients (QD, 12; BID, 15; TID, 7) at visit 1, 32 patients (QD, 11; BID, 14; TID, 7) at visit 2, and 25 patients (QD, 7; BID, 11; TID, 7) at visit 3. The rates of negative PCR result for QD, BID, and TID regimens were 18.2, 0, and 14.3% at visit 2, and 85.7, 72.7, and 85.7% at visit 3, respectively. The median values of bacterial load for QD, BID, and TID groups at visit 1 were 1.4 × 106, 8.2 × 105, and 5.4 × 105 copies/μL. At visit 2, they comprised 3.8 × 103, 1.1 × 103, and 2.8 × 103 copies/μL, respectively, whereas at visit 3, GAS copies were mostly undetectable. There was no statistical difference in the negative results and median value of GAS copies between regimens at any stage.ConclusionsOur results obtained by a molecular biology approach indicated that the QD regimen was as effective in eradicating GAS infection as BID or TID.Trial registrationUMIN000036083 / March 12, 2019.
Highlights
MethodsThe subjects were children (≧3 years of age) diagnosed with group A streptococcal (GAS) pharyngitis
Culture tests have demonstrated that once-daily administration of amoxicillin may be effective in the treatment of group A streptococcal (GAS) pharyngitis
Rapid antigen and culture tests are recommended for children over the age of three, who are suspected to have a GAS infection [3]
Summary
The study subjects underwent rapid antigen testing with ImunoAce StrepA (Tauns, Shizuoka, Japan), using a throat swab and isolation culture tests, in which GAS was detected. The main outcomes were the negative rate and a number of GAS copies determined by PCR in throat swabs collected after the start of treatment. Differences in these parameters were compared between QD, BID, and TID regimens. DNA extraction and quantitative PCR Bacterial load was calculated from the solution of throat swab samples. Clinical symptoms and signs, and the rate of negative PCR results between treatment groups were compared by the Student’s unpaired t-test and Fisher’s exact test. Written informed consent was provided by a parent and/or legal proxy
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