Multicentre comparison of azithromycin versus erythromycin in the treatment of paediatric pharyngitis or tonsillitis caused by group A streptococci

Abstract

In this open study, 93 children (aged 2-12 years) with a clinical diagnosis of pharyngitis or tonsillitis caused by Streptococcus pyogenes (culture and/or ELISA test positive) were given azithromycin, as a single daily dose of 10 mg/kg (maximum 500 mg) for three days (n = 46); or erythromycin ethylsuccinate, 30-50 mg/kg daily given in three divided doses, for ten days (n = 47). Forty-four of 46 azithromycin patients, and 46 of 47 erythromycin patients, had S. pyogenes isolated at baseline and were included in the clinical and bacteriological analyses. At the end of treatment (day 10-12), 38 (86%) of the 44 azithromycin patients were considered cured, four (9%) improved, one (2%) failed and one relapsed. In the erythromycin group, 30 of 46 (65%) were considered cured, 15 (33%) improved and one (2%) failed. Eradication of S. pyogenes was achieved in 40 of 44 (91%) and 45 of 46 (98%) azithromycin and erythromycin patients, respectively. Re-occurrence of S. pyogenes, assessed 28-32 days after start of treatment, occurred in five of 37 (14%) azithromycin patients (three with clinical symptoms) and five of 39 (13%) erythromycin patients (four with clinical signs). There were no statistically significant differences in clinical or bacteriological efficacy between the two groups. Both drugs were well-tolerated, with side-effects (mainly gastrointestinal) reported in five of 46 (11%) azithromycin patients and in six of 47 (13%) erythromycin patients, one of whom withdrew from treatment. No laboratory abnormalities were observed in the azithromycin patients, but were recorded in two of 43 (5%) erythromycin patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Safety and effectiveness of azithromycin in the treatment of respiratory infections in children

“…A total of 89.1% of patients reported relief of symptoms within 3 days from the start of treatment. Although the effectiveness remained in the ranges of earlier clinical studies, we must interpret our own study results cautiously because, contrary to the present study, earlier studies were randomized, double blind, comparative and the etiology was confirmed in cases of streptococcal pharyngitis [23][24][25][26][27][28][29][30][31][32][33] . There are other factors which might contribute to the rapid response, such as the mild-to-moderate course of the disease and also a possible viral etiology.…”

“…In clinical trials, in the treatment of respiratory tract diseases, azithromycin has shown to be either better-or equally well-tolerated, compared to other antibiotics [23][24][25][26][27][28][29][30][31][32][33] .…”

Higher Dosages of Azithromycin Are More Effective in Treatment of Group A Streptococcal Tonsillopharyngitis

“…Twenty-five of these trials were excluded from the meta-analysis for the following reasons: the short-course treatment did not use azithromycin; the data presented were a re-publication of previous data already present in trials included in the meta-analysis; or the publication could not be obtained for review. This left 19 publications [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]; of these, 1 publication used 10-day courses of 2 different comparator antibiotics [24], 2 publications used 2 different dose regimens for azithromycin, [22,27], and 3 publications were abstracts presented at national conferences [29][30][31].…”

“…Garcia Callejo et al[24] 10 mg/kg per day for 3 days (74) Amoxicillin-clavulanate(19); NOTE. PQ, patient/parent questioned; QS, Jadad quality score; RC, record card; TC, tablet count.…”

Defining the optimum treatment regimen for azithromycin in acute tonsillopharyngitis

“…36 Between 1993 and 2002, there have been 11 publications from 12 prospective randomized studies in children with GABHS pharyngitis comparing the clinical efficacy and bacterial eradication rates of azithromycin with other antibiotics (mainly penicillin V). [37][38][39][40][41][42][43][44][45][46][47] All of the studies measured clinical and bacteriologic success at end of treatment, usually 10 to 17 days after study enrollment, and 10 of the 11 studies measured clinical and bacteriologic success at the end of study, usually 1 month after study enrollment. Analysis of these studies shows that clinical efficacy at end of therapy with azithromycin is high (Ͼ90%) and at least comparable (in two studies significantly better) than comparators.…”