A Comparison of the Effects and Side‐effects of Penicillin v and Ampicillin in the Treatment of Scarlet Fever

Abstract

Penicillin V is extremely efficacious against infections caused by haemolytic streptococci. A comparison with the broad-spectrum penicillin, ampicillin, is justified since this drug, too, has a highly effective bactericidal action on pyogenic streptococci. On the basis of a small series of cases in France ampicillin has even been considered "l'antibiotique de choix" for the treatment of scarlet fever (1). On the other hand a fairly high incidence of side-effects is reported from the use of ampicillin. especially in the form of exanthem (3, 4, 5, 6), which may be a restraining factor. An aetiologically and clinically uniform disease such as scarlet fever should be a suitable object for the study of the antibacterial and clinical efficacy of ampicillin as well as of its side-effects in comparison with penicillin V, our hitherto best per oral penicillin for scarlet fever therapy. MATERIAL AND METHODSThe study covers the period 1962-64. The patients were treated in the same department. As from the morning of the second day in hospital alternate cases of scarlet fever were put on ampicillin (Doctacil1in)-dose 125 mg x 3 for ages 1-4 years and 250 mg Y 3 for ages 5-13 yearsand penicillin V (Meropenin)-dose 100,000 IU (60 mg) \I 3 and 200,000 IU (120 mg) x 3 for the two age groups. The treatment lasted for 10 days. Daily tests for haemolytic streptococci were made during the 10 days in hospital and thereafter at follow-ups one and three weeks after discharge. The antistreptolysin titre of children above 4 years of age was determined on admission, after one week and at the second follow-up, i.e. about 2'/? weeks after discharge. Each series consisted of 110 cases. RESULTS Clinical effect.The results were satisfactory with both drugs. No complications occurred, either purulent or of toxic-allergic origin in the form of myocarditis or nephritis.The duration of the fever as from the onset of the disease was for the penicillin V series 4.2+ 0.16 days and for the ampicillin series 4.6k0.23 days, and during the period in hospital 1.920.10 and 2.3 0.19 days respectively-thus a rather shorter duration for the penicillin V patients, but not statistically significant.The sedimeniation rate on admission to hospital and one week later was for the penicillin V series 28.92 1.4 and 1 1 . 6 2 0.7 mm/hr, respectively, and for the ampicillin series 28.3 5 1.3 and 11.4 & 0.7 mm/hr, thus practically no difference.Bacteriological effect. This is illustrated in Fig. 1, which includes only those patients who had a positive test on the first day (98 in the ampicillin, 93 in the penicillin V series). All of the penicillin V series were negative on the third day. In the ampicillin series two patients did not become free from bacteria until the fourth day, and one not until the fifth. Streptococcal recurrence occurred rather more often in the ampicillin patients at the check-up after one week (15.4% against 9.1 % ). The difference is not significant. During the follow-up period pharyngeal symptoms accompanied by fever were noted in 12 ampicillin...

Antibacterial Therapy for Acute Group A Streptococcal Pharyngotonsillitis

“…Prior studies have shown bacteriologic eradication rates with 10-day ampicillin and amoxicillin treatments to be equal to 10-day treatments with penicillin. [42][43][44][45][46][47][48] Two 6-day studies of 663 patients (270 received amoxicillin) showed that 6 days of amoxicillin therapy is as effective as 10 days of penicillin. [49,50] Cohen et al, [49] in a prospective, comparative, open, randomized, multicenter trial involving 321 children, demonstrated that 6-day amoxicillin treatment was followed by an 84% bacteriologic success rate compared with 85% after 10 days of therapy with penicillin.…”

The Oral Absorption of Ampicillin, Pivampicillin and Amoxycillin in Infants and Children

“…In treatment of shigella infections, however, amoxycillin was found t o be less effective than ampicillin both in virro a n d in vivo (Nelson & Haltalin 1974). Whenever possible as for example in treatment of tonsillitis, pc V should be preferred to ampicillin since it has fewer side-effects (Strom 1968, Stillerman et a/. 1974.…”

Antibiothérapie par voie générale en pratique courante dans les infections respiratoires hautes de l'adulte et l'enfant. Argumentaire

“…Aminopénicillines orales. L'efficacité de l'ampicilline et de l'amoxicilline pendant dix jours est comparable à celle de la pénicilline V pendant dix jours [85][86][87][88][89][90][91]. Des études menées avec un traitement par amoxicilline en six jours démontrent une efficacité équivalente à la pénicilline V pendant dix jours en prenant en compte les taux d'éradication bactérienne et une meilleure observance chez l'enfant et chez l'adulte [92][93][94].…”