Efficacy of Cephalexin Two vs. Three Times Daily vs. Cefadroxil Once Daily for Streptococcal Tonsillopharyngitis

Abstract

The purpose of this study was to compare the bacteriologic and clinical efficacy of oral cephalexin twice vs. three times daily vs. cefadroxil once daily as therapy for group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis. A prospective open-label, observational cohort study was conducted over 18 months (January 2000-June 2001). Children enrolled had an acute onset of symptoms and signs of a tonsillopharyngeal illness and a laboratory-documented GABHS infection. Follow-up examination and laboratory testing occurred 21 +/- 4 days following enrollment. Two hundred seventy-one patients were enrolled (intent to treat group): 63 received cephalexin twice daily, 124 received cephalexin three times daily, and 84 received cefadroxil once daily. Fifty-three children did not return for the follow-up visit, leaving 218 patients in the per-protocol group: 54 cephalexin twice-daily treated, 94 cephalexin 3-times daily treated, and 70 cefadroxil once-daily treated. In the per-protocol group, bacteriologic cure for those treated with cephalexin twice daily was 87%, for cephalexin 3 times daily, it was 81% and for cefadroxil once daily it was 81% (p = 0.61). The clinical cure rate for cephalexin twice-daily treatment was 91%; for three-times daily, it was 86%; and for cefadroxil once daily, it was 84% (p = 0.56). Because treatment allocation was not randomized, logistic regression analysis was used to adjust for treatment group differences. Younger age of patient was significantly associated with bacteriologic (p = 0.04) and clinical (p = 0.01) failure independent of treatment group but in the adjusted logistic model no differences were found among the 3 treatment regimens. Cephalexin dosed twice daily or three times daily and cefadroxil dosed once daily appear equivalent in bacteriologic and clinical cure of GABHS tonsillopharyngitis.

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

“…Oral penicillin must be administered 2 to 4 times a day for 10 days in order to achieve maximal rates of GAS eradication (445). Several antimicrobial agents, including clarithromycin, cefuroxime, and cefixime, can successfully eradicate GAS from the pharynx when administered for Յ5 days (446,447), and effective eradication with once-daily dosing has been described for amoxicillin, azithromycin, and various cephalosporins (448,449). Importantly, the endpoints of these studies are generally the eradication of GAS and not symptomatic improvement or prevention of ARF, the two main clinical reasons for treatment.…”

Symptomatic Relapse of Group A β-Hemolytic Streptococcal Tonsillopharyngitis in Children

“…1 Our group has also recently reported a failure rate of 24% with amoxicillin at a daily dosage range of 10 to more than 70 mg/kg compared with failure rate of 36% with oral penicillin at a daily dosage range of 10 to more than 70 mg/kg 2 and a 13% failure rate with cephalexin. 3 These data were collected as part of clinical trials and raise the question of whether such relatively high rates of failure occur in everyday pediatric practice and how frequently these patients return for care because of symptoms recurrence. We therefore undertook the current study to examine the frequency of return office visits within 5 and 20 days after completion of therapy for GABHS tonsillopharyngitis with penicillin, amoxicillin, first-generation cephalosporins, or β-lactamase antibiotics that are more stable, such as second-generation or thirdgeneration cephalosporins or amoxicillin-clavulanate.…”