Different antibiotic treatments for group A streptococcal pharyngitis

van Driel, Mieke L., De Sutter, An I. M., Keber, Natalija, Habraken, Hilde and Christiaens, Thierry (2010) Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database of Systematic Reviews, 10: CD004406.1-CD004406.64. doi:10.1002/14651858.CD004406.pub2

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Author van Driel, Mieke L.
De Sutter, An I. M.
Keber, Natalija
Habraken, Hilde
Christiaens, Thierry
Title Different antibiotic treatments for group A streptococcal pharyngitis
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2010
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004406.pub2
Issue 10
Start page CD004406.1
End page CD004406.64
Total pages 64
Place of publication John Wiley & Sons
Publisher Oxford, United Kingdom
Language eng
Formatted abstract
Background
Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated.
Objectives
We assessed the comparative efficacy of different antibiotics on clinical outcomes, relapse, complications and adverse events in GABHS tonsillopharyngitis.
Search methods
We searched The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3) which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to July Week 4, 2010) and EMBASE (1974 to August 2010).
Selection criteria
Randomised, double-blind trials comparing different antibiotics reporting at least one of the following: clinical cure, clinical relapse, complications, adverse events.
Data collection and analysis
Two authors independently screened trials for inclusion and extracted data.
Main results
Seventeen trials (5352 participants) were included; 16 compared with penicillin (six with cephalosporins, six with macrolides, three with carbacephem and one with sulfonamides), one trial compared clindamycin and ampicillin. Randomisation reporting, allocation concealment and blinding were poor.
There was no difference in symptom resolution between cephalosporins and penicillin (intention-to-treat (ITT) analysis; N = 5; n = 2018; odds ratio for absence of resolution of symptoms (OR) 0.79, 95% confidence interval (CI) 0.55 to 1.12). Clinical relapse was lower with cephalosporins (N = 4; n = 1386; OR 0.55, 95% CI 0.31 to 0.99); overall number needed to treat to benefit (NNTB) 50), but found only in adults (OR 0.42, 95% CI 0.20 to 0.88; NNTB 33). There were no differences between macrolides and penicillin. Carbacephem showed better symptom resolution post-treatment (N = 3; n = 795; OR 0.70, 95% CI 0.49 to 0.99; NNTB 14), but only in children (N = 2; n = 233; OR 0.57, 95% CI 0.33 to 0.99; NNTB 8.3). Children experienced more adverse events with macrolides (N = 1, n = 489; OR 2.33; 95% CI 1.06 to 5.15).
Authors' conclusions
Evidence is insufficient for clinically meaningful differences between antibiotics for GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be recommended as first choice.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Intervention Review # CD004406

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Discipline of General Practice Publications
School of Medicine Publications
 
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