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Meta-Analysis
. 2012 Aug 15;2012(8):CD004872.
doi: 10.1002/14651858.CD004872.pub3.

Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children

Saleh Altamimi  1 , Adli Khalil, Khalid A Khalaiwi, Ruth A Milner, Martin V Pusic, Mohammed A Al Othman
Affiliations
Meta-Analysis

Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children

Saleh Altamimi et al. Cochrane Database Syst Rev. .

Abstract

Background: The standard duration of treatment for children with acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral penicillin is 10 days. Shorter duration antibiotics may have comparable efficacy.

Objectives: To summarize the evidence regarding the efficacy of two to six days of newer oral antibiotics (short duration) compared to 10 days of oral penicillin (standard duration) in treating children with acute GABHS pharyngitis.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 3) which contains the Cochrane Acute Respiratory Infections Group's Specialized Register, MEDLINE (January 1966 to March week 3, 2012) and EMBASE (January 1990 to April 2012).

Selection criteria: Randomized controlled trials (RCTs) comparing short duration oral antibiotics to standard duration oral penicillin in children aged 1 to 18 years with acute GABHS pharyngitis.

Data collection and analysis: Two review authors scanned the titles and abstracts of retrieved citations and applied the inclusion criteria. We retrieved included studies in full, and extracted data. Two review authors independently assessed trial quality.

Main results: We included 20 studies with 13,102 cases of acute GABHS pharyngitis. The updated search did not identify any new eligible studies; the majority of studies were at high risk of bias. However, the majority of the results were consistent. Compared to standard duration treatment, the short duration treatment studies had shorter periods of fever (mean difference (MD) -0.30 days, 95% confidence interval (CI) -0.45 to -0.14) and throat soreness (MD -0.50 days, 95% CI -0.78 to -0.22); lower risk of early clinical treatment failure (odds ratio (OR) 0.80, 95% CI 0.67 to 0.94); no significant difference in early bacteriological treatment failure (OR 1.08, 95% CI 0.97 to 1.20) or late clinical recurrence (OR 0.95, 95% CI 0.83 to 1.08). However, the overall risk of late bacteriological recurrence was worse in the short duration treatment studies (OR 1.31, 95% CI 1.16 to 1.48), although no significant differences were found when studies of low dose azithromycin (10 mg/kg) were eliminated (OR 1.06, 95% CI 0.92 to 1.22). Three studies reported long duration complications. Out of 8135 cases of acute GABHS pharyngitis, only six cases in the short duration treatment versus eight in the standard duration treatment developed long-term complications in the form of glomerulonephritis and acute rheumatic fever, with no statistically significant difference (OR 0.53, 95% CI 0.17 to 1.64).

Authors' conclusions: Three to six days of oral antibiotics had comparable efficacy compared to the standard duration 10-day course of oral penicillin in treating children with acute GABHS pharyngitis. . In areas where the prevalence of rheumatic heart disease is still high, our results must be interpreted with caution.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Funnel plot of comparison: 2 Clinical efficacy, outcome: 2.1 Clinical treatment failure (early).
4
4
Funnel plot of comparison: 2 Clinical efficacy, outcome: 2.2 Clinical treatment failure (late).
1.1
1.1. Analysis
Comparison 1 Duration of clinical symptoms, Outcome 1 Duration of fever.
1.2
1.2. Analysis
Comparison 1 Duration of clinical symptoms, Outcome 2 Duration of sore throat.
2.1
2.1. Analysis
Comparison 2 Clinical efficacy, Outcome 1 Early clinical treatment failure.
2.2
2.2. Analysis
Comparison 2 Clinical efficacy, Outcome 2 Late clinical recurrence.
3.1
3.1. Analysis
Comparison 3 Bacteriological efficacy, Outcome 1 Early bacteriological treatment failure.
3.2
3.2. Analysis
Comparison 3 Bacteriological efficacy, Outcome 2 Late bacteriological recurrence.
4.1
4.1. Analysis
Comparison 4 Side effects, Outcome 1 Side effects.
5.1
5.1. Analysis
Comparison 5 Compliance, Outcome 1 Non‐compliance.
6.1
6.1. Analysis
Comparison 6 Complications, Outcome 1 Complications.
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References

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