A Cochrane review [Abstract] 1 included 20 studies with a total of 13 102 subjects between 1 to 18 years of age. The most common intervention antibiotic was azithromycin (n = 6). Other intervention antibiotics were different cephalosporins (n = 9), erythromycin (n = 2), clarithromycin (n = 3), amoxacillin (n = 1), amoxacillin/clavulanate (n = 2), penicillin V (n =1) and jasomycin (n = 1).
Compared to standard duration treatment with 10 days oral penicillin, the short duration (two to six days of oral antibiotics) treatment had shorter periods of fever (MD -0.30 days, 95% 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 (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). Low-dose azithromycin (10 mg/kg/day) for three days was significantly inferior to standard duration treatment and other short duration treatments with regard to bacteriological eradication. There were more side effects with the short duration treatment, however, all were self-limiting, and mainly mild to moderate vomiting, diarrhea, or abdominal pain.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions).
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