WASHINGTON — Oral cephalosporins, whether given for 5 or 10 days, are more effective than penicillin in the treatment of Group A streptococcal tonsillopharyngitis, Dr. Janet R. Casey and Dr. Michael E. Pichichero reported in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Data were derived from a metaanalysis involving a total of 11,426 patients from 47 trials in the United States and Europe, said Dr. Casey and Dr. Pichichero, both of the Elmwood Pediatric Group and the University of Rochester, N.Y.
Among 10 European studies comparing 10 days of penicillin versus 10 days of cephalosporins in the bacterial eradication of GAS in a total of 1,656 pediatric patients with tonsillopharyngitis, the odds ratio was 4.27 in favor of cephalosporins. In 25 such U.S. trials, involving 5,469 patients, cephalosporins didn't fare quite as well, although they were still superior to penicillin, with an odds ratio of 2.70.
Clinical cures for 10-day regimens were similar for the two continents, with odds ratios of 2.38 in Europe (7 trials/1,488 children) and 2.46 in the United States (22 trials/4,990 children).
Studies of 4–5 days of cephalosporins versus 10 days of penicillin were analyzed in a total of 6 European and U.S. trials involving 1,149 adults and in 6 trials from both continents involving 3,152 children.
Odds ratios for bacterial eradication favored the shorter cephalosporin regimen for the 9 combined European trials (1.30) and even more so in the 3 U.S. trials (2.41). On both continents, the superiority of cephalosporins in bacterial eradication was more pronounced in children than in adults (odds ratios 1.34 vs. 1.09 in Europe and 2.94 vs. 1.65 in the United States).
Bacterial cure rates with cephalosporins were strongly superior to penicillin in trials from the United Kingdom, Germany, France, and Sweden, with odds ratios ranging from 3.35 to 4.77. While cephalosporin cure rates remained consistent in the different countries, penicillin bacterial cure rates varied widely, with a low of 66% in Sweden. That's probably because 2 of the 3 trials conducted there were among patients with recurrent GAS tonsillopharyngitis, in whom penicillin would be expected to be even less effective, Dr. Casey and Dr. Pichichero said at the meeting, sponsored by the American Society for Microbiology.
Miriam E. Tucker