Treatment of Streptococcal Pharyngitis with Different Antibiotic Regimens

Lester, R

doi:10.1177/000992287401300308

Cited by 14 publications

(8 citation statements)

References 6 publications

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“…Five studies reported IM penicillin therapy; results were consistent with our findings for antibiotics overall[28,39,54,59,64]. Snellman et al found 1/15 (6.7%) children were culture-positive at 24 hours following single dose benzathine penicillin[28].…”

supporting

confidence: 82%

“…Ten studies investigated macrolides [28,31,39,42,45,46,48,53,59,67], three clindamycin [39,45,58] and two co-trimoxazole [40,60] with a wide range of dosing regimens (Supplementary Appendix D). Only one study reported on throat cultures taken at 24 hours following initiation of treatment with a macrolide; 6/15 (40%) remained culture positive [28].…”

Section: Resultsmentioning

confidence: 99%

“…Lester et al . reported no positive cases at day 5 among 126 patients treated either with Benzathine penicillin or combined Benzathine Penicillin/Procaine Penicillin G [39]. Colcher et al .…”

Section: Resultsmentioning

confidence: 99%

“…Snellman et al found 1/15 (6.7%) children were culture-positive at 24 hours following single dose benzathine penicillin[28]. Lester et al reported no positive cases at day 5 among 126 patients treated either with Benzathine penicillin or combined Benzathine Penicillin/Procaine Penicillin G[39]. Colcher et al found 3/100 (3%) to be culture-positive at day 9…”

mentioning

confidence: 99%

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Time to negative throat culture following initiation of antibiotics for pharyngeal group AStreptococcus: a systematic review and meta-analysis to inform public health control measures

McGuire¹,

Li²,

Collin³

et al. 2022

Preprint

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Background: Public health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12-24 hours from antibiotic initiation to prevent onward transmission requires a strong evidence-base. Methods: We conducted a systematic review (PROSPERO CRD42021290364) and meta-analysis to estimate the pooled proportion of individuals who remain GAS culture-positive at set intervals after initiation of antibiotics. We searched Ovid MEDLINE (1946-), EMBASE (1974-) and the Cochrane library. We included interventional or observational studies with ten or more participants reporting rates of GAS throat culture during antibiotics for culture confirmed GAS pharyngitis, scarlet fever, and asymptomatic pharyngeal GAS carriage. We did not apply age, language, or geographical restrictions. Findings: Of 5,058 unique records identified, 43 were included; 37 (86%) randomised controlled studies, three (7%) non-randomised controlled trials and three (7%) before-and-after studies. The proportion of individuals who remained culture-positive at day 1, day 2, and day 3-9 were 6.9% (95% CI 2.7-16.8%), 5.4% (95% CI 2.1-13.3%) and 2.6% (95% CI 1.6-4.2%). For penicillins and cephalosporins, day 1 positivity was 6.5% (95% CI 2.5-16.1%) and 1.6% (95% CI 0.04-42.9%) respectively. Overall, for 9.1% (95% CI 7.3-11.3), throat swabs collected after completion of therapy were GAS culture-positive. Interpretation: Our review provides evidence that antibiotics for pharyngeal GAS achieve a high rate of culture conversion within 24 hours but highlights the need for further research given the methodological limitations of published studies and imprecision of pooled estimates. Further evidence is needed for non-beta-lactam antibiotics and for asymptomatic individuals.

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supporting

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Time to negative throat culture following initiation of antibiotics for pharyngeal group AStreptococcus: a systematic review and meta-analysis to inform public health control measures

McGuire¹,

Li²,

Collin³

et al. 2022

Preprint

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“…Ten studies investigated macrolides [31,[33][34][35][36][37][38][39][40][41], three clindamycin [34,36,42] and two co-trimoxazole [43,44],…”

Section: Culture Positivity During Antibiotic Treatmentmentioning

confidence: 99%

Time to negative throat culture following initiation of antibiotics for pharyngeal group A Streptococcus: a systematic review and meta-analysis up to October 2021 to inform public health control measures

McGuire¹,

Li²,

Collin³

et al. 2023

Eurosurveillance

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Background Public health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12–24 h from antibiotic initiation to prevent onward transmission requires a strong evidence base. Aim To estimate the pooled proportion of individuals who remain GAS culture-positive at set intervals after initiation of antibiotics through a systematic literature review (PROSPERO CRD42021290364) and meta-analysis. Methods We searched Ovid MEDLINE (1946–), EMBASE (1974–) and Cochrane library. We included interventional or observational studies with ≥ 10 participants reporting rates of GAS throat culture positivity during antibiotic treatment for culture-confirmed GAS pharyngitis, scarlet fever and asymptomatic pharyngeal GAS carriage. We did not apply age, language or geographical restrictions. Results Of 5,058 unique records, 43 were included (37 randomised controlled studies, three non-randomised controlled trials and three before-and-after studies). The proportion of individuals remaining culture-positive on day 1, day 2 and days 3–9 were 6.9% (95% CI: 2.7–16.8%), 5.4% (95% CI: 2.1–13.3%) and 2.6% (95% CI: 1.6–4.2%). For penicillins and cephalosporins, day 1 positivity was 6.5% (95% CI: 2.5–16.1%) and 1.6% (95% CI: 0.04–42.9%), respectively. Overall, for 9.1% (95% CI: 7.3–11.3), throat swabs collected after completion of therapy were GAS culture-positive. Only six studies had low risk of bias. Conclusions Our review provides evidence that antibiotics for pharyngeal GAS achieve a high rate of culture conversion within 24 h but highlights the need for further research given methodological limitations of published studies and imprecision of pooled estimates. Further evidence is needed for non-beta-lactam antibiotics and asymptomatic individuals.

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Clarithromycin suspension vs penicillin V suspension in children with streptococcal pharyngitis

2000

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Clarithromycin, an advanced-generation macrolide antibiotic, has demonstrated excellent in vitro activity against group A beta-hemolytic streptococcus (GABHS). Potent activity against Streptococcus pyogenes and a favorable pharmacokinetic profile have made it a reasonable alternative for treatment of patients with streptococcal pharyngitis. The safety and efficacy of clarithromycin and penicillin V were compared in a randomized, investigator-blind study. Children 6 months to 12 years of age received 5 days of clarithromycin suspension 7.5 mg/kg twice daily (n = 268) or 10 days of penicillin V suspension 13.3 mg/kg three times daily (n = 260). Patients were evaluated for signs and symptoms of pharyngitis, and throat swabs for culture were obtained prior to therapy, at the end of therapy, and at follow-up. Clarithromycin and penicillin V produced comparable rates of clinical success (cure + improvement) at the posttreatment (97% and 94%) and follow-up (81% and 82%) evaluations. The GABHS eradication rate, however, was significantly higher with clarithromycin (94% vs 78%, P < .001). Both drugs were well tolerated; gastrointestinal complaints were similar and mild. Resistance did not occur with the short course of clarithromycin or the standard regimen of penicillin V. Five days' treatment with clarithromycin was superior to 10 days of penicillin in eradicating S. pyogenes.

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Treatment of Streptococcal Pharyngitis with Different Antibiotic Regimens

Cited by 14 publications

References 6 publications

Time to negative throat culture following initiation of antibiotics for pharyngeal group AStreptococcus: a systematic review and meta-analysis to inform public health control measures

Time to negative throat culture following initiation of antibiotics for pharyngeal group AStreptococcus: a systematic review and meta-analysis to inform public health control measures

Time to negative throat culture following initiation of antibiotics for pharyngeal group A Streptococcus: a systematic review and meta-analysis up to October 2021 to inform public health control measures

Clarithromycin suspension vs penicillin V suspension in children with streptococcal pharyngitis

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