Immediate vs. delayed treatment of Group A beta-hemolytic streptococcal pharyngitis with penicillin V

El-Daher, Nayef; Hijazi, Sa'ad; Rawashdeh, N. M.; Al-Khalil, Ihsan; Abu-Ektaish, Faisal Mohammed; Abdel-Latif, Darwish Ishak

doi:10.1097/00006454-199102000-00010

Cited by 71 publications

(30 citation statements)

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“…Five randomized controlled studies and 1 meta-analysis have examined the effect of immediate antibiotics on resolution of symptoms, 1 of which was completed since publication of the first principles of judicious use of antibiotics. [37][38][39][40][41] These studies provide strong evidence that antibiotic therapy for children with pharyngitis and confirmation of GAS shortens the duration of symptoms, including sore throat and headache, by approximately 1 day. These benefits are apparent within as few as 3 days.…”

Section: Benefitsmentioning

confidence: 79%

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

Hersh¹,

Jackson²,

Hicks³

et al. 2013

Pediatrics

235

199

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Most upper respiratory tract infections are caused by viruses and require no antibiotics. This clinical report focuses on antibiotic prescribing strategies for bacterial upper respiratory tract infections, including acute otitis media, acute bacterial sinusitis, and streptococcal pharyngitis. The principles for judicious antibiotic prescribing that are outlined focus on applying stringent diagnostic criteria, weighing the benefits and harms of antibiotic therapy, and understanding situations when antibiotics may not be indicated. The principles can be used to amplify messages from recent clinical guidelines for local guideline development and for patient communication; they are broadly applicable to antibiotic prescribing in general.

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Section: Benefitsmentioning

confidence: 79%

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

Hersh¹,

Jackson²,

Hicks³

et al. 2013

Pediatrics

235

199

View full text Add to dashboard Cite

show abstract

“…Also, there is concern that if a physician treats streptococcal pharyngitis too early in its course (before an antibody response can be mounted), the risk of relapse increases. 4,68,69 Our analysis incorporated neither a benefit nor a penalty for early therapy per se (any benefit of early therapy would favor the Empiric Therapy strategy, particularly from the parent's perspective).…”

Section: Parent's Perspectivementioning

confidence: 99%

Management of Sore Throats in Children

Tsevat

Kotagal

1999

Arch Pediatr Adolesc Med

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“…Finally efficacy trials with close follow up probably improve compliance and effect sizes compared with routine practice, where half of the medication is not taken. If the study findings can be generalised to everyday practice it means that seven children with two out of four of the Centor criteria would have to be treated to prevent one case of worsening of illness, with the associated disadvantages of side effects, reduced local and systemic immunity, and the cycle of recurrence 3 – 6…”

mentioning

confidence: 99%

“…It would be reasonable to share the results of this study—that seven children with the Centor criteria need to be treated to prevent worsening illness in one child—with parents. If parents were keen to have antibiotics the case would still be very strong for offering delayed antibiotics for children with two out of the four Centor criteria, since in unwell children a delayed prescribing strategy (waiting for 48 hours, rather than the normal five days) in three placebo controlled trials for patients with streptococcal pharyngitis did not result in complications 4 – 6…”

mentioning

confidence: 99%

More valid criteria may be needed

Little

2003

BMJ

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Objective To assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat. Design Randomised, double blind, placebo controlled trial. Setting 43 family practices in the Netherlands. Participants 156 children aged 4-15 who had a sore throat for less than seven days and at least two of the four Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate). Interventions Patients were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days. Main outcome measures Duration of symptoms, mean consumption of analgesics, number of days of absence from school, occurrence of streptococcal sequelae, eradication of the initial pathogen, and recurrences of sore throat after six months. Results Penicillin treatment was not more beneficial than placebo in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A streptococci. In the groups randomised to seven days of penicillin, three days of penicillin, or placebo, one, two, and eight children, respectively, experienced a streptococcal sequela. Conclusion Penicillin treatment had no beneficial effect in children with sore throat on the average duration of symptoms. Penicillin may, however, reduce streptococcal sequelae.

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Immediate vs. delayed treatment of Group A beta-hemolytic streptococcal pharyngitis with penicillin V

Cited by 71 publications

References 0 publications

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

Management of Sore Throats in Children

More valid criteria may be needed

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