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Evidence summaries

Short Versus Standard Duration Antibiotic Therapy for Acute Streptococcal Pharyngitis in Children

Three to six days treatment with oral antibiotics appears to have comparable efficacy to the standard duration 10 days of oral penicillin in treating children with acute streptococcal GABHS pharyngitis. Level of evidence: "B"

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).

    References

    • Altamimi S, Khalil A, Khalaiwi KA et al. Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev 2012;(8):CD004872. [PubMed]

Primary/Secondary Keywords