New approaches to the treatment of group A streptococcal pharyngitis

Abstract

An orally administered antimicrobial regimen for the treatment of pharyngitis caused by group A beta-hemolytic streptococci that could be given once daily and for less than 10 days would be convenient and might improve compliance, decrease cost, and result in fewer side effects compared with a regimen given multiple times daily for 10 days. Previous attempts to administer oral penicillin once daily or for less than 10 days were not successful. Several cephalosporins and azithromycin have been reported to be effective when administered once daily or for less than 10 days. However, large, comprehensive studies have not been performed. In addition, the spectra of these cephalosporins and azithromycin are much broader than that of penicillin, and, even when they are administered for short courses, they are more expensive. Therefore, these novel regimens cannot be endorsed and should not supplant penicillin as the agent of choice. In contrast, once-daily amoxicillin therapy appears to be effective, is inexpensive, and has a narrower spectrum of antimicrobial activity; if these findings are confirmed by additional investigations, it could become an alternative regimen for the treatment of pharyngitis caused by group A beta-hemolytic streptococci.

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

“…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. Also, such antibiotic alternatives tend to be more expensive than standard therapy and, with broader spectra of activity than penicillin, may produce greater perturbations to the normal flora (450).…”

Diagnosis of Acute Pharyngitis in Children

“…Зарегистрированы вспышки пищевой инфекции и стрептококками группы G, но роль их в раз-витии эндемичного острого фарингита до конца не ясна. В литературе представлены факты возможного эпидеми-ческого распространения в детской популяции фаринги-та, обусловленного стрептококками группы G. Например, в одном из детских амбулаторных центров США в один сезон этот вид патогенов был выявлен у 25% обратив-шихся по поводу фарингита и тонзиллита детей, причем у большинства из них при ДНК-типировании зарегистри-рован один и тот же штамм [8]. Роль стрептококков груп-пы G в развитии фарингита недооценивается по разным причинам.…”

Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis

“…Furthermore, several attempts to use a once daily oral dose of penicillin V to effectively treat pharyngitis have failed [24].…”