Different antibiotic treatments for group A streptococcal pharyngitis
Background Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta‐haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. Objectives To asse...
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| creator | van Driel, Mieke L De Sutter, An IM Habraken, Hilde Thorning, Sarah Christiaens, Thierry van Driel, Mieke L |
| description | Background
Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta‐haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated.
Objectives
To assess the evidence on the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing relapse; and (d) preventing complications (suppurative complications, acute rheumatic fever, post‐streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk‐benefit of antibiotic treatment for streptococcal pharyngitis.
Search methods
We searched CENTRAL (2016, Issue 3), MEDLINE Ovid (1946 to March week 3, 2016), Embase Elsevier (1974 to March 2016), and Web of Science Thomson Reuters (2010 to March 2016). We also searched clinical trials registers.
Selection criteria
Randomised, double‐blind trials comparing different antibiotics and reporting at least one of the following: clinical cure, clinical relapse, or complications or adverse events, or both.
Data collection and analysis
Two review authors independently screened trials for inclusion, and extracted data using standard methodological procedures as recommended by Cochrane. We assessed risk of bias of included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and used the GRADE tool to assess the overall quality of evidence for the outcomes.
Main results
We included 19 trials (5839 randomised participants); seven compared penicillin with cephalosporins, six compared penicillin with macrolides, three compared penicillin with carbacephem, one trial compared penicillin with sulphonamides, one trial compared clindamycin with ampicillin, and one trial compared azithromycin with amoxicillin in children. All included trials reported clinical outcomes. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. The overall quality of the evidence assessed using the GRADE tool was low for the outcome 'resolution of symptoms' in the intention‐to‐treat (ITT) analysis and very low for the outcomes 'resolution of symptoms' of evaluable participants and for adverse events. We downgraded the quality of evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both, heterogeneity, and |
| doi_str_mv | 10.1002/14651858.CD004406.pub4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6457741</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1859741836</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4734-a16eeb03e4392e4f2c5ab948e725270e2f82f84d3d8d6080cbf01122f706584b3</originalsourceid><addsrcrecordid>eNqFUU1PAyEUJEZja_UvNHv00gosC_RiUtv6kTTxomfCstBidpcVtpr-e9n0I9WLCQnkzbyZxzwAhgiOEYT4DhGaIZ7x8WwOISGQjptNTs5AvwNGHXJ-8u6BqxA-IEzpBLNL0MOMIsIw74PF3Bqjva7bRNatza1rrUpar2VbxWJIjPPJyrtNk0yTEOtN65RTSpZJs5Z-W69sa8M1uDCyDPpmfw_A--PibfY8Wr4-vcymy5EiLCUjiajWOUw1SSdYE4NVJvMJ4ZrhDDOoseHxkCIteEEhhyo3ECGMDYM04yRPB-B-pxs_W-lCxQm9LEXjbRVnEU5a8Rup7Vqs3JegJGOMoChwuxfw7nOjQysqG5QuS1lrtwkihjWJPJ7SSKU7qvIuBK_N0QZB0e1AHHYgDjvozElsHJ4OeWw7hB4JDzvCty31VsQ41z76_6P7x-UH6w2YbQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1859741836</pqid></control><display><type>article</type><title>Different antibiotic treatments for group A streptococcal pharyngitis</title><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><source>Cochrane Library</source><creator>van Driel, Mieke L ; De Sutter, An IM ; Habraken, Hilde ; Thorning, Sarah ; Christiaens, Thierry ; van Driel, Mieke L</creator><creatorcontrib>van Driel, Mieke L ; De Sutter, An IM ; Habraken, Hilde ; Thorning, Sarah ; Christiaens, Thierry ; van Driel, Mieke L</creatorcontrib><description>Background
Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta‐haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated.
Objectives
To assess the evidence on the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing relapse; and (d) preventing complications (suppurative complications, acute rheumatic fever, post‐streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk‐benefit of antibiotic treatment for streptococcal pharyngitis.
Search methods
We searched CENTRAL (2016, Issue 3), MEDLINE Ovid (1946 to March week 3, 2016), Embase Elsevier (1974 to March 2016), and Web of Science Thomson Reuters (2010 to March 2016). We also searched clinical trials registers.
Selection criteria
Randomised, double‐blind trials comparing different antibiotics and reporting at least one of the following: clinical cure, clinical relapse, or complications or adverse events, or both.
Data collection and analysis
Two review authors independently screened trials for inclusion, and extracted data using standard methodological procedures as recommended by Cochrane. We assessed risk of bias of included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and used the GRADE tool to assess the overall quality of evidence for the outcomes.
Main results
We included 19 trials (5839 randomised participants); seven compared penicillin with cephalosporins, six compared penicillin with macrolides, three compared penicillin with carbacephem, one trial compared penicillin with sulphonamides, one trial compared clindamycin with ampicillin, and one trial compared azithromycin with amoxicillin in children. All included trials reported clinical outcomes. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. The overall quality of the evidence assessed using the GRADE tool was low for the outcome 'resolution of symptoms' in the intention‐to‐treat (ITT) analysis and very low for the outcomes 'resolution of symptoms' of evaluable participants and for adverse events. We downgraded the quality of evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both, heterogeneity, and wide confidence intervals (CIs).
There was a difference in symptom resolution in favour of cephalosporins compared with penicillin (evaluable patients analysis odds ratio (OR) for absence of resolution of symptoms 0.51, 95% CI 0.27 to 0.97; number needed to treat to benefit (NNTB) 20, N = 5, n = 1660; very low quality evidence). However, this was not statistically significant in the ITT analysis (OR 0.79, 95% CI 0.55 to 1.12; N = 5, n = 2018; low quality evidence). Clinical relapse was lower for cephalosporins compared with penicillin (OR 0.55, 95% CI 0.30 to 0.99; NNTB 50, N = 4, n = 1386; low quality evidence), but this was found only in adults (OR 0.42, 95% CI 0.20 to 0.88; NNTB 33, N = 2, n = 770). There were no differences between macrolides and penicillin for any of the outcomes. One unpublished trial in children found a better cure rate for azithromycin in a single dose compared to amoxicillin for 10 days (OR 0.29, 95% CI 0.11 to 0.73; NNTB 18, N = 1, n = 482), but there was no difference between the groups in ITT analysis (OR 0.76, 95% CI 0.55 to 1.05; N = 1, n = 673) or at long‐term follow‐up (evaluable patients analysis OR 0.88, 95% CI 0.43 to 1.82; N = 1, n = 422). Children experienced more adverse events with azithromycin compared to amoxicillin (OR 2.67, 95% CI 1.78 to 3.99; N = 1, n = 673). Compared with penicillin carbacephem showed better symptom resolution post‐treatment in adults and children combined (ITT analysis OR 0.70, 95% CI 0.49 to 0.99; NNTB 14, N = 3, n = 795), and in the subgroup analysis of children (OR 0.57, 95% CI 0.33 to 0.99; NNTB 8, N = 1, n = 233), but not in the subgroup analysis of adults (OR 0.75, 95% CI 0.46 to 1.22, N = 2, n = 562). Children experienced more adverse events with macrolides compared with penicillin (OR 2.33, 95% CI 1.06 to 5.15; N = 1, n = 489). Studies did not report on long‐term complications so it was unclear if any class of antibiotics was better in preventing serious but rare complications.
Authors' conclusions
There were no clinically relevant differences in symptom resolution when comparing cephalosporins and macrolides with penicillin in the treatment of GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective than penicillin for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be regarded as a first choice treatment for both adults and children. All studies were in high‐income countries with low risk of streptococcal complications, so there is need for trials in low‐income countries and Aboriginal communities where risk of complications remains high.</description><identifier>ISSN: 1465-1858</identifier><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD004406.pub4</identifier><identifier>PMID: 27614728</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Ampicillin ; Antibiotics ; Anti‐Bacterial Agents ; Cephalosporins ; Child health ; Clindamycin ; Ear, nose & throat ; Macrolides ; Medicine General & Introductory Medical Sciences ; Penicillins ; Pharyngitis ; Pharyngitis/Tonsillitis (Sore throat) ; Pharynx ; Randomized Controlled Trials as Topic ; Streptococcal Infections ; Streptococcus pyogenes ; Sulfonamides ; Tonsillitis (acute)/pharyngitis ; Treatment</subject><ispartof>Cochrane database of systematic reviews, 2016-09, Vol.2016 (9), p.CD004406</ispartof><rights>Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4734-a16eeb03e4392e4f2c5ab948e725270e2f82f84d3d8d6080cbf01122f706584b3</citedby><cites>FETCH-LOGICAL-c4734-a16eeb03e4392e4f2c5ab948e725270e2f82f84d3d8d6080cbf01122f706584b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27614728$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Driel, Mieke L</creatorcontrib><creatorcontrib>De Sutter, An IM</creatorcontrib><creatorcontrib>Habraken, Hilde</creatorcontrib><creatorcontrib>Thorning, Sarah</creatorcontrib><creatorcontrib>Christiaens, Thierry</creatorcontrib><creatorcontrib>van Driel, Mieke L</creatorcontrib><title>Different antibiotic treatments for group A streptococcal pharyngitis</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta‐haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated.
Objectives
To assess the evidence on the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing relapse; and (d) preventing complications (suppurative complications, acute rheumatic fever, post‐streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk‐benefit of antibiotic treatment for streptococcal pharyngitis.
Search methods
We searched CENTRAL (2016, Issue 3), MEDLINE Ovid (1946 to March week 3, 2016), Embase Elsevier (1974 to March 2016), and Web of Science Thomson Reuters (2010 to March 2016). We also searched clinical trials registers.
Selection criteria
Randomised, double‐blind trials comparing different antibiotics and reporting at least one of the following: clinical cure, clinical relapse, or complications or adverse events, or both.
Data collection and analysis
Two review authors independently screened trials for inclusion, and extracted data using standard methodological procedures as recommended by Cochrane. We assessed risk of bias of included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and used the GRADE tool to assess the overall quality of evidence for the outcomes.
Main results
We included 19 trials (5839 randomised participants); seven compared penicillin with cephalosporins, six compared penicillin with macrolides, three compared penicillin with carbacephem, one trial compared penicillin with sulphonamides, one trial compared clindamycin with ampicillin, and one trial compared azithromycin with amoxicillin in children. All included trials reported clinical outcomes. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. The overall quality of the evidence assessed using the GRADE tool was low for the outcome 'resolution of symptoms' in the intention‐to‐treat (ITT) analysis and very low for the outcomes 'resolution of symptoms' of evaluable participants and for adverse events. We downgraded the quality of evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both, heterogeneity, and wide confidence intervals (CIs).
There was a difference in symptom resolution in favour of cephalosporins compared with penicillin (evaluable patients analysis odds ratio (OR) for absence of resolution of symptoms 0.51, 95% CI 0.27 to 0.97; number needed to treat to benefit (NNTB) 20, N = 5, n = 1660; very low quality evidence). However, this was not statistically significant in the ITT analysis (OR 0.79, 95% CI 0.55 to 1.12; N = 5, n = 2018; low quality evidence). Clinical relapse was lower for cephalosporins compared with penicillin (OR 0.55, 95% CI 0.30 to 0.99; NNTB 50, N = 4, n = 1386; low quality evidence), but this was found only in adults (OR 0.42, 95% CI 0.20 to 0.88; NNTB 33, N = 2, n = 770). There were no differences between macrolides and penicillin for any of the outcomes. One unpublished trial in children found a better cure rate for azithromycin in a single dose compared to amoxicillin for 10 days (OR 0.29, 95% CI 0.11 to 0.73; NNTB 18, N = 1, n = 482), but there was no difference between the groups in ITT analysis (OR 0.76, 95% CI 0.55 to 1.05; N = 1, n = 673) or at long‐term follow‐up (evaluable patients analysis OR 0.88, 95% CI 0.43 to 1.82; N = 1, n = 422). Children experienced more adverse events with azithromycin compared to amoxicillin (OR 2.67, 95% CI 1.78 to 3.99; N = 1, n = 673). Compared with penicillin carbacephem showed better symptom resolution post‐treatment in adults and children combined (ITT analysis OR 0.70, 95% CI 0.49 to 0.99; NNTB 14, N = 3, n = 795), and in the subgroup analysis of children (OR 0.57, 95% CI 0.33 to 0.99; NNTB 8, N = 1, n = 233), but not in the subgroup analysis of adults (OR 0.75, 95% CI 0.46 to 1.22, N = 2, n = 562). Children experienced more adverse events with macrolides compared with penicillin (OR 2.33, 95% CI 1.06 to 5.15; N = 1, n = 489). Studies did not report on long‐term complications so it was unclear if any class of antibiotics was better in preventing serious but rare complications.
Authors' conclusions
There were no clinically relevant differences in symptom resolution when comparing cephalosporins and macrolides with penicillin in the treatment of GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective than penicillin for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be regarded as a first choice treatment for both adults and children. All studies were in high‐income countries with low risk of streptococcal complications, so there is need for trials in low‐income countries and Aboriginal communities where risk of complications remains high.</description><subject>Ampicillin</subject><subject>Antibiotics</subject><subject>Anti‐Bacterial Agents</subject><subject>Cephalosporins</subject><subject>Child health</subject><subject>Clindamycin</subject><subject>Ear, nose & throat</subject><subject>Macrolides</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Penicillins</subject><subject>Pharyngitis</subject><subject>Pharyngitis/Tonsillitis (Sore throat)</subject><subject>Pharynx</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Streptococcal Infections</subject><subject>Streptococcus pyogenes</subject><subject>Sulfonamides</subject><subject>Tonsillitis (acute)/pharyngitis</subject><subject>Treatment</subject><issn>1465-1858</issn><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><recordid>eNqFUU1PAyEUJEZja_UvNHv00gosC_RiUtv6kTTxomfCstBidpcVtpr-e9n0I9WLCQnkzbyZxzwAhgiOEYT4DhGaIZ7x8WwOISGQjptNTs5AvwNGHXJ-8u6BqxA-IEzpBLNL0MOMIsIw74PF3Bqjva7bRNatza1rrUpar2VbxWJIjPPJyrtNk0yTEOtN65RTSpZJs5Z-W69sa8M1uDCyDPpmfw_A--PibfY8Wr4-vcymy5EiLCUjiajWOUw1SSdYE4NVJvMJ4ZrhDDOoseHxkCIteEEhhyo3ECGMDYM04yRPB-B-pxs_W-lCxQm9LEXjbRVnEU5a8Rup7Vqs3JegJGOMoChwuxfw7nOjQysqG5QuS1lrtwkihjWJPJ7SSKU7qvIuBK_N0QZB0e1AHHYgDjvozElsHJ4OeWw7hB4JDzvCty31VsQ41z76_6P7x-UH6w2YbQ</recordid><startdate>20160911</startdate><enddate>20160911</enddate><creator>van Driel, Mieke L</creator><creator>De Sutter, An IM</creator><creator>Habraken, Hilde</creator><creator>Thorning, Sarah</creator><creator>Christiaens, Thierry</creator><creator>van Driel, Mieke L</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160911</creationdate><title>Different antibiotic treatments for group A streptococcal pharyngitis</title><author>van Driel, Mieke L ; De Sutter, An IM ; Habraken, Hilde ; Thorning, Sarah ; Christiaens, Thierry ; van Driel, Mieke L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4734-a16eeb03e4392e4f2c5ab948e725270e2f82f84d3d8d6080cbf01122f706584b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Ampicillin</topic><topic>Antibiotics</topic><topic>Anti‐Bacterial Agents</topic><topic>Cephalosporins</topic><topic>Child health</topic><topic>Clindamycin</topic><topic>Ear, nose & throat</topic><topic>Macrolides</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Penicillins</topic><topic>Pharyngitis</topic><topic>Pharyngitis/Tonsillitis (Sore throat)</topic><topic>Pharynx</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Streptococcal Infections</topic><topic>Streptococcus pyogenes</topic><topic>Sulfonamides</topic><topic>Tonsillitis (acute)/pharyngitis</topic><topic>Treatment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Driel, Mieke L</creatorcontrib><creatorcontrib>De Sutter, An IM</creatorcontrib><creatorcontrib>Habraken, Hilde</creatorcontrib><creatorcontrib>Thorning, Sarah</creatorcontrib><creatorcontrib>Christiaens, Thierry</creatorcontrib><creatorcontrib>van Driel, Mieke L</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Driel, Mieke L</au><au>De Sutter, An IM</au><au>Habraken, Hilde</au><au>Thorning, Sarah</au><au>Christiaens, Thierry</au><au>van Driel, Mieke L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Different antibiotic treatments for group A streptococcal pharyngitis</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2016-09-11</date><risdate>2016</risdate><volume>2016</volume><issue>9</issue><spage>CD004406</spage><pages>CD004406-</pages><issn>1465-1858</issn><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta‐haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated.
Objectives
To assess the evidence on the comparative efficacy of different antibiotics in: (a) alleviating symptoms (pain, fever); (b) shortening the duration of the illness; (c) preventing relapse; and (d) preventing complications (suppurative complications, acute rheumatic fever, post‐streptococcal glomerulonephritis). To assess the evidence on the comparative incidence of adverse effects and the risk‐benefit of antibiotic treatment for streptococcal pharyngitis.
Search methods
We searched CENTRAL (2016, Issue 3), MEDLINE Ovid (1946 to March week 3, 2016), Embase Elsevier (1974 to March 2016), and Web of Science Thomson Reuters (2010 to March 2016). We also searched clinical trials registers.
Selection criteria
Randomised, double‐blind trials comparing different antibiotics and reporting at least one of the following: clinical cure, clinical relapse, or complications or adverse events, or both.
Data collection and analysis
Two review authors independently screened trials for inclusion, and extracted data using standard methodological procedures as recommended by Cochrane. We assessed risk of bias of included studies according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and used the GRADE tool to assess the overall quality of evidence for the outcomes.
Main results
We included 19 trials (5839 randomised participants); seven compared penicillin with cephalosporins, six compared penicillin with macrolides, three compared penicillin with carbacephem, one trial compared penicillin with sulphonamides, one trial compared clindamycin with ampicillin, and one trial compared azithromycin with amoxicillin in children. All included trials reported clinical outcomes. Reporting of randomisation, allocation concealment, and blinding was poor in all trials. The overall quality of the evidence assessed using the GRADE tool was low for the outcome 'resolution of symptoms' in the intention‐to‐treat (ITT) analysis and very low for the outcomes 'resolution of symptoms' of evaluable participants and for adverse events. We downgraded the quality of evidence mainly due to lack of (or poor reporting of) randomisation or blinding, or both, heterogeneity, and wide confidence intervals (CIs).
There was a difference in symptom resolution in favour of cephalosporins compared with penicillin (evaluable patients analysis odds ratio (OR) for absence of resolution of symptoms 0.51, 95% CI 0.27 to 0.97; number needed to treat to benefit (NNTB) 20, N = 5, n = 1660; very low quality evidence). However, this was not statistically significant in the ITT analysis (OR 0.79, 95% CI 0.55 to 1.12; N = 5, n = 2018; low quality evidence). Clinical relapse was lower for cephalosporins compared with penicillin (OR 0.55, 95% CI 0.30 to 0.99; NNTB 50, N = 4, n = 1386; low quality evidence), but this was found only in adults (OR 0.42, 95% CI 0.20 to 0.88; NNTB 33, N = 2, n = 770). There were no differences between macrolides and penicillin for any of the outcomes. One unpublished trial in children found a better cure rate for azithromycin in a single dose compared to amoxicillin for 10 days (OR 0.29, 95% CI 0.11 to 0.73; NNTB 18, N = 1, n = 482), but there was no difference between the groups in ITT analysis (OR 0.76, 95% CI 0.55 to 1.05; N = 1, n = 673) or at long‐term follow‐up (evaluable patients analysis OR 0.88, 95% CI 0.43 to 1.82; N = 1, n = 422). Children experienced more adverse events with azithromycin compared to amoxicillin (OR 2.67, 95% CI 1.78 to 3.99; N = 1, n = 673). Compared with penicillin carbacephem showed better symptom resolution post‐treatment in adults and children combined (ITT analysis OR 0.70, 95% CI 0.49 to 0.99; NNTB 14, N = 3, n = 795), and in the subgroup analysis of children (OR 0.57, 95% CI 0.33 to 0.99; NNTB 8, N = 1, n = 233), but not in the subgroup analysis of adults (OR 0.75, 95% CI 0.46 to 1.22, N = 2, n = 562). Children experienced more adverse events with macrolides compared with penicillin (OR 2.33, 95% CI 1.06 to 5.15; N = 1, n = 489). Studies did not report on long‐term complications so it was unclear if any class of antibiotics was better in preventing serious but rare complications.
Authors' conclusions
There were no clinically relevant differences in symptom resolution when comparing cephalosporins and macrolides with penicillin in the treatment of GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective than penicillin for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be regarded as a first choice treatment for both adults and children. All studies were in high‐income countries with low risk of streptococcal complications, so there is need for trials in low‐income countries and Aboriginal communities where risk of complications remains high.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>27614728</pmid><doi>10.1002/14651858.CD004406.pub4</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2016-09, Vol.2016 (9), p.CD004406 |
| issn | 1465-1858 1469-493X 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6457741 |
| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Cochrane Library |
| subjects | Ampicillin Antibiotics Anti‐Bacterial Agents Cephalosporins Child health Clindamycin Ear, nose & throat Macrolides Medicine General & Introductory Medical Sciences Penicillins Pharyngitis Pharyngitis/Tonsillitis (Sore throat) Pharynx Randomized Controlled Trials as Topic Streptococcal Infections Streptococcus pyogenes Sulfonamides Tonsillitis (acute)/pharyngitis Treatment |
| title | Different antibiotic treatments for group A streptococcal pharyngitis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-19T03%3A07%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Different%20antibiotic%20treatments%20for%20group%20A%20streptococcal%20pharyngitis&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=van%20Driel,%20Mieke%20L&rft.date=2016-09-11&rft.volume=2016&rft.issue=9&rft.spage=CD004406&rft.pages=CD004406-&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD004406.pub4&rft_dat=%3Cproquest_pubme%3E1859741836%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1859741836&rft_id=info:pmid/27614728&rfr_iscdi=true |