Penicillin for acute sore throat in children: randomised, double blind trial

Abstract

Objective To assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat. Design Randomised, double blind, placebo controlled trial. Setting 43 family practices in the Netherlands. Participants 156 children aged 4-15 who had a sore throat for less than seven days and at least two of the four Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate). Interventions Patients were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days. Main outcome measures Duration of symptoms, mean consumption of analgesics, number of days of absence from school, occurrence of streptococcal sequelae, eradication of the initial pathogen, and recurrences of sore throat after six months. Results Penicillin treatment was not more beneficial than placebo in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A streptococci. In the groups randomised to seven days of penicillin, three days of penicillin, or placebo, one, two, and eight children, respectively, experienced a streptococcal sequela. Conclusion Penicillin treatment had no beneficial effect in children with sore throat on the average duration of symptoms. Penicillin may, however, reduce streptococcal sequelae.

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

“…Five randomized controlled studies and 1 meta-analysis have examined the effect of immediate antibiotics on resolution of symptoms, 1 of which was completed since publication of the first principles of judicious use of antibiotics. [37][38][39][40][41] These studies provide strong evidence that antibiotic therapy for children with pharyngitis and confirmation of GAS shortens the duration of symptoms, including sore throat and headache, by approximately 1 day. These benefits are apparent within as few as 3 days.…”

Which is the best method to trace group A streptococci in sore throat patients: culture or GAS antigen test?

“…This should be linked to the fact that healthy carriers of GAS have a lower number of CFU in their throat cultures (4). A weak positive semi-quantitative reaction may possibly be a way of singling out carriers not in need of antibiotic treatment, although our data do not allow any firm conclusion on this topic.…”

Absceso y flegmón periamigdalino ¿Lo estamos haciendo bien?

“…Esto concuerda con reportes de otros autores como Gidley y cols, en cuya publicación el 50% de los pacientes con infección de espacios profundos del cuello había recibido terapia antimicrobiana previa a la hospitalización 5 . Sin embargo, un estudio randomizado realizado en niños con faringoamigdalitis que compara el tratamiento con penicilina oral por 7 días versus 3 días y placebo, demostró que el porcentaje de infección del espacio peritonsilar es mayor en el grupo placebo 13 .…”