Strep Throat: Cephalosporin Beat Penicillin
WASHINGTON — A short-course regimen with a cephalosporin was more effective than a 10-day regimen with penicillin for curing strep throat, based on a metaanalysis of 14 studies done in adults and children.
A short-course regimen, which usually lasts 5 days, runs counter to what most physicians were taught to use to treat tonsillopharyngitis caused by group A streptococci, Janet R. Casey, M.D., said in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
But physicians must realize that many patients won't take an antibiotic for 10 days, and so they should consider prescribing a 5-day course. The results from the metaanalysis “are a start toward changing physician behavior,” said Dr. Casey, a pediatrician at the University of Rochester (N.Y.).
The metaanalysis included 14 studies with a total of 1,880 patients treated with one of seven cephalosporins and 2,760 patients treated with penicillin. The most commonly used drug was cefpodoxime (Vantin), in four studies, followed by cefuroxime (Ceftin), in three studies. Cefixime (Suprax) and cefdinir (Omnicef) were each used in two studies, and cefadroxil (Duricef), cefotiam, and cefprozil (Cefzil) were each used in a single study.
Twelve of the studies involved a 5-day course of cephalosporin. One study used a 4-day regimen of cefuroxime, and another a 4-day course of used cefixime.
Overall, the results of these 14 studies showed that treatment with a short-course of a cephalosporin produced a 63% higher cure rate than a 10-day course with penicillin, a difference that was statistically significant.
The value of a short-course regimen was highlighted in an analysis of four studies that each compared a 5-day course of a cephalosporin with a 10-day course of the same drug. The results showed that compliance with the 5-day regimens was three-fold greater than compliance with the 10-day regimens, Dr. Casey said at the conference, sponsored by the American Society for Microbiology.
The only short-course regimens currently approved by the Food and Drug Administration for treating strep throat are 5 days of treatment with azithromycin, cefdinir, or cefpodoxime, Dr. Casey told FAMILY PRACTICE NEWS.
The metaanalysis included additional studies that compared short-course regimens that used penicillin, amoxicillin, or a macrolide against 10 days of treatment with penicillin or another comparator drug.
The results showed that the short-course penicillin regimens (5 or 7 days' duration) were inferior to a 10-day regimen and that 6 days of treatment with amoxicillin or 5 days of treatment with a macrolide was similar in efficacy to a 10-day regimen.
