SEARCH

SEARCH BY CITATION

Abstract

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How recent is the evidence
  10. Research gaps

This is a summary of Cochrane review, published in this issue of EBCH, first published as: van Driel ML, De Sutter AIM, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis (Review). Cochrane Database of Systematic Reviews 2010, Issue 10. Art.No.: CD004406. DOI: 10.1002/14651858.CD004406.pub2. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration


Objectives

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How recent is the evidence
  10. Research gaps
  • The aim of this review was to assess the comparative efficacy of different antibiotics on clinical outcomes, relapse, complications and adverse events in group A beta-haemolytic streptococci tonsillopharyngitis.

Relevance

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How recent is the evidence
  10. Research gaps
  • Pharyngitis is a common upper respiratory tract infection. Antibiotics are often prescribed to treat this condition.

  • Many guidelines recommend penicillin as a first choice, with erythromycin preferred for people with penicillin allergies. To date, resistance of group A beta-haemolytic streptococci to penicillin has not been documented and resistance to erythromycin is still low. However, resistance is a concern.

  • Penicillin and erythromycin are cheap and cost-effective. In spite of this, physicians continue to prescribe broad-spectrum antibiotics.

Participants

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How recent is the evidence
  10. Research gaps
  • Seventeen trials with 5352 participants were included in this review (1722 children in child-only trials-unclear how many children in mixed adult/children trials).

Results

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How recent is the evidence
  10. Research gaps

Cephalosporins versus penicillin (six trials):

  • Intention to treat analyses found no difference in resolution of symptoms post-treatment, resolution of symptoms within 24 hours of treatment, sore throat and fever.

  • Cephalosporins significantly decreased the overall incidence of relapse (OR: 0.55; 95% CI: 0.31, 0.99), but this effect was not significant when looking at child-only data.

  • No complications were reported and there was no difference in adverse events.

Macrolides versus penicillin (six trials):

  • There was no significant difference in resolution of symptoms post-treatment, sore throat, fever or incidence of relapse.

  • Overall, there was no significant difference in adverse events, but a subgroup analysis of children only found significantly more adverse events associated with macrolides (OR: 2.33; 95% CI: 1.06, 5.15).

Carbacephem versus penicillin (three trials):

  • In an intention to treat analysis, significantly more participants treated with carbacephem experienced resolution of symptoms post-treatment (OR: 0.70; 95% CI: 0.49, 0.99), an effect that remained significant when looking at children only (OR: 0.57; 95% CI: 0.33, 0.99).

  • There was no difference in incidence of relapse or adverse events.

One trial each of sulfonamide versus penicillin and clindamycin versus ampicillin found no significant difference in adverse events.

Implications

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How recent is the evidence
  10. Research gaps
  • There is insufficient evidence to alter current guideline recommendations for the treatment of patients with group A beta-haemolytic streptococci tonsillopharyngitis.

  • If antibiotics are to be prescribed, based on the evidence, penicillin can still be considered as the first choice in both adults and children.

Research gaps

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How recent is the evidence
  10. Research gaps
  • Further research is required to investigate the observed differences in clinical efficacy between adults and children.

  • Trials with longer follow-up are warranted to investigate the impact of different antibiotics on the prevention of complications such as rheumatic fever and acute glomerulonephritis. They seem to be more prevalent in low-income and high-risk communities (e.g. Australian indigenous communities); therefore, studies in these specific high-risk communities are needed.

Statistical abbreviations

CI: confidence interval

OR: odds ratio