Azithromycin versus penicillin V in the treatment of paediatric patients with acute streptococcal pharyngitis/tonsillitis

Abstract

The efficacy and safety of azithromycin and penicillin V in the treatment of acute streptococcal pharyngitis/tonsillitis in paediatric patients were compared in a double-blind, double-dummy prospective study. A total of 489 children (age range, 2-13 years) were randomized to receive treatment with penicillin V (125-250 mg 4 x daily for 10 days) or azithromycin in an oral suspension (10 or 20 mg/kg 1 x daily for 3 days). Only patients with baseline cultures positive for Streptococcus pyogenes and complete clinical and microbiological assessments at the end of the therapy and follow-up one month later were included in the efficacy analysis. A satisfactory clinical response (cure or improvement) was recorded in 99% of the 10 mg/kg azithromycin group, 100% of the 20 mg/kg azithromycin group, and 97% of the penicillin V group at the end of therapy (day 12-14). At the follow-up evaluation (day 28-30), relapse rates in patients cured or improved at the end of therapy were 6%, 5%, and 2%, respectively. Bacteriological eradication rates at the end of therapy were 98% in both azithromycin groups and 92% in patients who received penicillin V (p = 0.011); pathogen recurrence was recorded at follow-up in 4% of the 20 mg/kg azithromycin group and in 6% of both the 10 mg/kg azithromycin and penicillin V groups. Treatment-related adverse events, the majority of mild to moderate severity, occurred in 13% of patients in the 20 mg/kg azithromycin group, 9% in the 10 mg/kg azithromycin group, and 5% in the penicillin V group. Azithromycin in a dosage of 10 or 20 mg/kg/day one daily for three days was as safe and effective as penicillin V administered four times daily in the treatment of paediatric patients with acute pharyngitis/tonsillitis.

Evaluation of short-term clinical efficacy of 3-day therapy with azithromycin in comparison with 5-day cefcapene-pivoxyl for acute streptococcal tonsillopharyngitis in primary care

“…Although this study did not investigate it, bacterial eradication by AZM therapy has been evaluated in several other studies. The dose of AZM tested in this study, 10 mg/kg for 3 days for children, resulted in bacterial eradication equivalent, in one study [9] but inferior in another [19], to a 10-day course of penicillin V. A higher dose of AZM (20 mg/kg) has been shown to result in a higher bacterial eradication rate. In general, bacterial resistance to macrolides is more prevalent than that to beta-lactams [20], and in-vitro susceptibility to AZM is inferior to that to CFPN-PI [21], as observed in our study.…”

“…First, it is not known if the dose of AZM in this study is optimum. The dose of AZM used in this study, 10 mg/kg for children, may be insufficient [18], although both 10 or 20 mg/kg/day for 3 days has been shown to be equally safe and effective [9]. Another study indicated that 10 mg/kg was associated with a higher bacteriological relapse and an increased risk of bacteria gaining resistance in comparison with 20 mg/kg [13].…”

“…In this context, the importance of our study lies in comparison of the efficacy of the alternative treatments, a newer cephalosporin and AZM. Furthermore, the clinical efficacy of AZM for GAS tonsillopharyngitis has only been evaluated after 10-17 days of enrollment [9,18]. Our study, where it was judged on the 4th and 8th days of the enrollment, added short-term clinical efficacy of AZM.…”

“…Azithromycin (AZM), a newer macrolide, was shown to have comparable T. Koga (&) Asakura Medical Association Hospital, 422-1 Raiharu, Asakura 838-0069, Japan e-mail: koga.tk@asakura-med.or.jp T. Rikimaru Fukuoka Sanno Hospital, Momochihama 3-6-45, Sawara-ku, Fukuoka 814-0001, Japan N. Tokunaga Tokunaga Clinic, Yokote 3-40-2, Minami-ku, Fukuoka 811-1311, Japan efficacy with penicillin [8,9] in a shorter administration period, indicating that AZM was an alternative treatment for GAS pharyngitis. However, few studies have compared the efficacy of a AZM with that of newer cephalosporins.…”

Antibiotikaempfindlichkeit wichtiger Erreger bakterieller Atemwegsinfektionen im Nordosten Deutschlands

“…Dies ist zurª aufdie ldonale Verbreitung entsprechend der seinerzeit ª Reisegewohnheiten. In den letzten Jahren kamen anstelle der Penicilline immer h~iufiger Makrolide zum Einsatz, vor aUem wegen der guten Vertr'Ÿ und der hohen Compliance durch einfache Einnahmemodi, zum Beispiel bei dem modemen Vertreter Azithromycin [29]. Parallel dazu muflte jedoch ein Anstieg der …”