Infectious Diseases| August 01 2008 Antibiotic Therapy for Streptococcal Pharyngitis Revisited AAP Grand Rounds (2008) 20 (2): 15–16. https://doi.org/10.1542/gr.20-2-15 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Antibiotic Therapy for Streptococcal Pharyngitis Revisited. AAP Grand Rounds August 2008; 20 (2): 15–16. https://doi.org/10.1542/gr.20-2-15 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: amoxicillin, antibiotic therapy, penicillin, sore throat, streptococcal, pharyngitis Source: Lennon DR, Farrell E, Martin DR, et al. Once-daily amoxicillin versus twice-daily penicillin V in group A β-haemolytic streptococcal pharyngitis. Arch Dis Child. 2008;93(6):474–478; doi:10.1136/adc.2006.113506 Investigators from New Zealand enrolled children 5–12 years of age in a prospective, randomized (1:1), nonblinded study to determine if oral once-daily amoxicillin (1500 mg if >30 kg, 750 mg if ≤30 kg; n=177) was noninferior to oral twice-daily penicillin V (500 mg if >30 kg, 250 mg if ≤ 30 kg; n=176) for treatment of group A β-hemolytic streptococcal (GAβHS) pharyngitis. Both drugs were given for 10 days. Children were enrolled between May 1996 and November 1998 if they presented with a sore throat and signs and symptoms suggestive of acute pharyngitis at a school clinic and had a throat culture positive for GAβHS. Noninferiority was defined as the upper confidence limit (CL) of a less than 10% difference in treatment effect between the two arms. Exclusion criteria included receipt of antibiotics in the previous 72 hours; history of acute rheumatic fever (ARF), cardiac or kidney disease; a rash suggestive of scarlet fever or mononucleosis; immunocompromised state, neoplasia, terminal illness, or neutropenia; and inclusion in the study during the prior 12 weeks. Children were seen for follow-up evaluations three additional times: days 3–6, days 12-16, and days 26–36. Throat cultures were performed on all follow-up visits and all GAβHS isolates were serotyped to determine failure (same serotype as initial isolate), relapse (same serotype as previous isolate with an intervening negative culture), or new acquisition (different serotype from the initial isolate). Impact of therapy on clinical course was also evaluated at each follow-up visit. A total of 353 patients were enrolled. Half the patients were Maori and a third were Pacific Islanders. Eleven children in the amoxicillin and seven in the penicillin group did not complete their course of treatment. Both drugs were well tolerated and adherence was 97% for the amoxicillin group and 98% for the penicillin group for receiving ≥80% of their doses. Amoxicillin was not inferior to penicillin V for bacteriologic failure at any follow-up visit. On the first follow-up visit, the treatment failure rate was 5.8% in the amoxicillin group and 6.2% in the penicillin group, while at the second follow-up visit, the treatment failure or relapse rate was 12.7% for the amoxicillin group and 11.9% for the penicillin group (upper 95% CL for difference between the groups of 6.5%). At the third follow-up visit the treatment failure or relapse rate was 10.7% in the amoxicillin group and 11.3% in the penicillin group (upper 95% CL for difference between the groups of 8.5%). The higher rate of positive cultures at the second and third follow-up visits compared with the first follow-up visit was primarily due to relapse. No significant differences in resolution of symptoms were noted between treatment groups. The authors conclude that once-daily amoxicillin is noninferior to twice-daily penicillin for the treatment of GAβHS pharyngitis in this population. Drs. Rathore and Barton have disclosed... You do not currently have access to this content.