Different antibiotic treatments for group A streptococcal pharyngitis

Driel, Mieke van; Sutter, An IM De; Habraken, Hilde; Thorning, Sarah; Christiaens, Thierry

doi:10.1002/14651858.cd004406.pub4

Cited by 55 publications

(27 citation statements)

References 89 publications

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“…Antibiotics are probably not helpful for pain relief in an episode of acute sore throat caused by viruses, but may help those with a bacterial infection. 14 15 Recommended management of sore throat varies widely, and table 1 summarises current guidelines.…”

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confidence: 99%

Corticosteroids for sore throat: a clinical practice guideline

Aertgeerts

Agoritsas

Siemieniuk

et al. 2017

BMJ

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What is the role of a single dose of oral corticosteroids for those with acute sore throat? Using the GRADE framework according to the BMJ Rapid Recommendation process, an expert panel make a weak recommendation in favour of corticosteroid use. The panel produced these recommendations based on a linked systematic review triggered by a large randomised trial published in April 2017. This trial reported that corticosteroids increased the proportion of patients with complete resolution of pain at 48 hours. Box 1 shows all of the articles and evidence linked in this Rapid Recommendation package. The infographic provides the recommendation together with an overview of the absolute benefits and harms of corticosteroids in the standard GRADE format. Table 2 below shows any evidence that has emerged since the publication of this article. Clinicians and their patients can find consultation decision aids to facilitate shared decision making in MAGICapp ( www.magicapp.org/goto/guideline/JjXYAL/section/j79pvn ).

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confidence: 99%

Corticosteroids for sore throat: a clinical practice guideline

Aertgeerts

Agoritsas

Siemieniuk

et al. 2017

BMJ

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“…GABHS is treatable through administration of appropriate antibiotics. Treatment reduces the period of communicability to 24 h in 80% of cases (Van Brusselen et al, 2014).…”

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confidence: 99%

“…The purpose of this article is to provide a comprehensive overview of the current state of knowledge pertaining to GABHS. Existing reviews are focused on particular aspects of the disease: clinical scoring systems for children ( Shaikh et al., 2012 ; Le Marechal et al., 2013 ; Cohen J. F. et al., 2015 ), clinical scoring systems for adults ( Aalbers et al., 2011 ), international guidelines for diagnosing and treating pharyngitis ( Matthys et al., 2007 ; Chiappini et al., 2011 ; Van Brusselen et al., 2014 ), rapid antigen detection tests (RADTs) for GABHS ( Gerber and Shulman, 2004 ; Stewart et al., 2014 ; Cohen et al., 2016 ), and antibiotic treatment ( Altamimi et al., 2012 ; Spinks et al., 2013 ; van Driel et al., 2016 ). In this review we cover methods for diagnosing the infection, clinical guidelines for strep throat, and the question of treatment.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review

Mustafa

Ghaffari

2020

Front. Cell. Infect. Microbiol.

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The most common bacterial cause of pharyngitis is infection by Group A b-hemolytic streptococcus (GABHS), commonly known as strep throat. 5-15% of adults and 15-35% of children in the United States with pharyngitis have a GABHS infection. The symptoms of GABHS overlap with non-GABHS and viral causes of acute pharyngitis, complicating the problem of diagnosis. A careful physical examination and patient history is the starting point for diagnosing GABHS. After a physical examination and patient history is completed, five types of diagnostic methods can be used to ascertain the presence of a GABHS infection: clinical scoring systems, rapid antigen detection tests, throat culture, nucleic acid amplification tests, and machine learning and artificial intelligence. Clinical guidelines developed by professional associations can help medical professionals choose among available techniques to diagnose strep throat. However, guidelines for diagnosing GABHS created by the American and European professional associations vary significantly, and there is substantial evidence that most physicians do not follow any published guidelines. Treatment for GABHS using analgesics, antipyretics, and antibiotics seeks to provide symptom relief, shorten the duration of illness, prevent nonsuppurative and suppurative complications, and decrease the risk of contagion, while minimizing the unnecessary use of antibiotics. There is broad agreement that antibiotics with narrow spectrums of activity are appropriate for treating strep throat. But whether and when patients should be treated with antibiotics for GABHS remains a controversial question. There is no clearly superior management strategy for strep throat, as significant controversy exists regarding the best methods to diagnose GABHS and under what conditions antibiotics should be prescribed.

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“…Increasing overall antimicrobial resistance and the lack of new antimicrobial agents emphasise the importance of correctly using existing antibiotics to their full potential 1213. A Cochrane review published in 2016 concluded that penicillin is the preferred first line treatment for pharyngotonsillitis caused by group A streptococcus in adults and children 14. This review compared penicillin with broader spectrum antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study

Ståhlgren

Tyrstrup

Edlund

et al. 2019

BMJ

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Objective To determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci. Design Open label, randomised controlled non-inferiority study. Setting 17 primary healthcare centres in Sweden between September 2015 and February 2018. Participants Patients aged 6 years and over with pharyngotonsillitis caused by group A streptococci and three or four Centor criteria (fever ≥38.5°C, tender lymph nodes, coatings of the tonsils, and absence of cough). Interventions Penicillin V 800 mg four times daily for five days (total 16 g) compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g). Main outcome measures Primary outcome was clinical cure five to seven days after the end of antibiotic treatment. The non-inferiority margin was prespecified to 10 percentage points. Secondary outcomes were bacteriological eradication, time to relief of symptoms, frequency of relapses, complications and new tonsillitis, and patterns of adverse events. Results Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3% (n=182/195) in the 10 day group (95% confidence interval −9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Adverse events were mainly diarrhoea, nausea, and vulvovaginal disorders; the 10 day group had higher incidence and longer duration of adverse events. Conclusions Penicillin V four times daily for five days was non-inferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen. Trial registration EudraCT 2015-001752-30; ClinicalTrials.gov NCT02712307 .

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Different antibiotic treatments for group A streptococcal pharyngitis

Cited by 55 publications

References 89 publications

Corticosteroids for sore throat: a clinical practice guideline

Corticosteroids for sore throat: a clinical practice guideline

Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review

Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study

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