Short course therapy with cefuroxime axetil for group A streptococcal tonsillopharyngitis in children

BACKGROUND.Tonsillopharyngitis caused by group A beta-hemolytic streptococci (GABHS) is common in pediatric clinical practice. Standard penicillin therapy may be associated with poor compliance, penicillin tolerance in GABHS and microbial copathogenicity. Alternative treatments are available (e.g. oral cephalosporins), and data suggest that shorter courses of these agents may be effective. OBJECTIVE.This open, randomized, multicenter study compared a conventional 10-day course of the broad spectrum oral cephalosporin, cefuroxime axetil, with a shorter 5-day course. METHODS.Cefuroxime axetil suspension, 10 mg/kg, was given twice daily to children (ages 3 to 13 years) screened for GABHS tonsillopharyngitis. Patients were assessed clinically and bacteriologically 4 to 7 days after completing the course and followed up at 21 to 28 days. Among 651 patients recruited 520 had throat cultures positive for GABHS and were randomized to treatment. RESULTS.In the 406 patients with microbiologically confirmed GABHS infection, eradication of the initial pathogen was recorded in 177 of 201 (88%) and 189 of 205 (92%) of patients in the 5- and 10-day groups, respectively, at posttreatment. At follow-up, 137 of 162 (85%) of patients in the 5-day group and 145 of 167 (87%) in the 10-day group maintained bacteriologic eradication. All posttreatment isolates of GABHS were susceptible to cefuroxime, and reinfection with a different serotype of GABHS was rare (≤2%) in both groups. The rates of recurrence of the pretreatment serotype were 10 and 7% in the 5- and 10-day groups, respectively. CONCLUSIONS.Short course therapy with cefuroxime axetil suspension may offer an effective alternative treatment to conventional regimens, with potential for better compliance and reduced costs.