Efficacy of Penicillin vs. Amoxicillin in Children with Group A Beta Hemolytic Streptococcal Tonsillopharyngitis

Abstract

The purpose of this study was to compare the bacteriologic and clinical efficacy of oral penicillin versus amoxicillin as first-line therapy for group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis. The prospective observational study was conducted over 18 months (January 2000-June 2001). Children enrolled had acute onset of symptoms and signs and a laboratory-documented GABHS tonsillopharyngitis illness. Follow-up examination and laboratory testing occurred 10 +/- 4 days following completion of treatment. In total, 389 patients were enrolled (intent-to-treat group): 195 received penicillin V and 194 received amoxicillin. Fifty-six of the penicillin-treated and 57 amoxicillin-treated patients refused to take the drug, or were noncompliant, or did not return for the follow-up visit, leaving 276 patients in the per-protocol group: 139 penicillin-treated and 137 amoxicillin-treated. Bacteriologic cure for amoxicillin-treated children occurred in 76% versus 64% in the penicillin-treated children (p = 0.04). The clinical cure rate for amoxicillin-treated children was 84% compared to 73% in the penicillin-treated children (p = 0.03). Since treatment allocation was not randomized, logistic regression analysis was used to adjust for treatment group differences. The odds ratio (OR) estimate for cure for patients in the amoxicillin versus penicillin V treatment group remained significant (OR = 1.84, 95% confidence interval 1.02-3.29); the same was true for dinical cure (OR = 1.99, 95% CI = 1.02-3.87). Amoxicillin may be superior to penicillin for bacteriologic and clinical cure of GABHS tonsillopharyngitis.

Once-daily amoxicillin versus twice-daily penicillin V in group A -haemolytic streptococcal pharyngitis

“…In other studies with more frequent dosing, amoxicillin bacteriological failure rates of 5%, 16% and 24% were reported with twice-daily treatment19 – 21 and between 3% and 15% with three-times daily dosing 19 22 – 26. In a careful review of bacteriological failure in oral penicillin trials, including assessment of comparability of protocols and use of serotyping, rates of 11–17% were found (10.5–12.5% at days 1–14 and 14–16.9% at days 1–60) 27…”

Acute Streptococcal Tonsillopharyngitis: A Review of Clinical Efficacy and Bacteriological Eradication

“…It should be noted that the response of only 55% was achieved in the study using a lower dose of penicillin. 19 The eradication rates with amoxycillin were 79% 19 and 76% 20 and the majority of cephalosporin antibiotics produced eradication rates of 90% or higher. 23 -26 Within the macrolide/azalide class of antibiotics, the lowest rate of eradication was achieved with azithromycin 10 mg/kg per day (38% and 58%), 21,22 followed by josamycin (82%), 32 and clarithromycin-modified release (83%).…”

Resistance of group A beta Haemolytic streptococcus isolated from children with tonsillopharyngitis against commonly used antibiotics

“…3,19 Ancak bir beta-laktam antibiyotik olan amoksisilin ya da amoksisilin-klavulanat kombinasyonun da penisiline alternatif ilaç olarak kullanılabileceği hatta penisilinden daha etkili olabileceği bildirilmiştir. 1,3,20 Çalışmamızda bakterinin penisilin ve amoksisilin duyarlılığının benzer olduğu ancak amoksisilin-klavulanat kombinasyonun duyarlılığının daha fazla olduğu ve bu kombinasyonun daha etkili olduğu görüldü. Ancak amoksisilin ya da amoksisilin-kalvulanat kombinasyonun penisiline göre daha geniş antimikrobiyal kapsama alanına sahip olması bu antibiyotiğe direnç gelişimini konusunda dikkatli olmayı gerektirecektir.…”