Randomized, single-blind evaluation of cefadroxil and phenoxymethyl penicillin in the treatment of streptococcal pharyngitis

Pichichero, M. E.; Disney, Frank A.; Aronovitz, Gerson; Talpey, William B.; Green, J L; Francis, Anne B.

doi:10.1128/aac.31.6.903

Cited by 43 publications

(18 citation statements)

References 20 publications

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“…Numerous comparative studies have shown that oral cephalosporins are more effective than or at least as effective as penicillin V for the treatment of streptococcal tonsillopharyngitis (5,7,9,10,11,12,18). This was also confirmed by the results of our study.…”

Section: Discussionsupporting

confidence: 81%

“…The bacteriological failure rate with cefprozil was 8.7%, which corresponds well to the figures reported in the literature for other cephalosporins such as cefalexin, cefadroxil, cefaclor, and cefuroxime axetil (5,8,9,11,18), ranging between 2 and 10%. Although the failure rate for penicillin was somewhat higher than that for cefprozil, the difference was not statistically significant.…”

Section: Discussionsupporting

confidence: 73%

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Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis

Milatovic

Adam

Hamilton

et al. 1993

Antimicrob Agents Chemother

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In a randomized multicenter study, the efficacy and safety of cefprozil were compared with those of penicillin in the treatment of group A streptococcal tonsillopharyngitis in children. Of the 409 patients enrolled, 323 were evaluable for their clinical and bacteriological responses; of these 323 children, 172 received cefprozil and 151 received penicillin V. The clinical responses in patients treated with cefprozil were significantly better than those in patients who received penicillin (95.3 versus 88.1%; P = 0.023). Eradication of the original serotype of group A streptococci was achieved in 91.3% of patients treated with cefprozil and 87.4% of patients treated with penicillin, the difference not being statistically significant (P = 0.125). However, there were significantly more symptomatic patients among the bacteriological failures in the penicillin group (68.4%) than in the cefprozil group (26.7%). 13-Lactamase-producing Staphylococcus aureus was more frequently isolated from the throat flora during penicillin therapy than during cefprozil treatment. No difference in the incidence of adverse events probably related or of unknown relationship to the study drugs was observed in the two treatment groups (5.2% of those treated with cefprozil and 6.0% of those treated with penicillin). Cefprozil can be considered a safe and reliable drug for the treatment of streptococcal pharyngitis in children.Streptococcal tonsillopharyngitis is one of the most common bacterial infections in pediatric patients. Penicillin is still considered the drug of choice, although failure rates of up to 30% have been reported (7,10,12). Since no penicillinresistant group A beta-hemolytic streptococci (GABHS) have been isolated, other reasons for the failure of therapy have been discussed, such as inactivation of penicillin by the P-lactamases produced by the concomitant throat flora or penicillin tolerance of the pathogen (2,13,14).Cephalosporins are stable to hydrolysis by the 1-lactamases of the bacteria that commonly colonize the mucous membranes of the upper respiratory tract. A meta-analysis of 19 different studies has shown that cephalosporins are more efficacious than penicillin in the treatment of streptococcal tonsillopharyngitis (19).Cefprozil is a new semisynthetic oral cephalosporin which has an in vitro spectrum that includes Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis (3, 6). Its half-life of 1.3 h allows for once-or twice-daily dosing. In one comparative study, cefprozil was evaluated for the treatment of streptococcal pharyngitis in adults, and it was found to be as efficacious as cefaclor (4). It has recently been approved in the United States for the treatment of upper respiratory tract infections in adults. We performed a multicenter trial comparing the efficacy and safety of cefprozil with those of penicillin V in 409 children with streptococcal tonsillopharyngitis. with severe renal and hepatic dysfunction, or those who had taken antibiotics within the previous 4...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 73%

Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis

Milatovic

Adam

Hamilton

et al. 1993

Antimicrob Agents Chemother

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“…In the present study, three doses of cefcanel daloxate were chosen to bracket the doses of cephalosporins that had been used in other tonsillitis studies (4)(5)(6)(7)(8)(9). The prodrug characteristics, pharmacokinetics and betalactamase stability of cefcanel daloxate were expected to produce better tolerance and less bacteriological failure .…”

Section: Discussionmentioning

confidence: 99%

Cefcanel Daloxate versus Penicillin in Acute Streptococcal Pharyngotonsillitis

Grunfeld

Sinclair

Nicolle

1993

Canadian Journal of Infectious Diseases and Medical Microbiolog

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A GRUNFELD, P SINCLAIR, LE NICOLLE AND THE CANADIAN TONSILLITIS STUDY GROUP. Cefcanel daloxate versus penicillin in acute streptococcal pharyngotonsillitis. Can J Infect Dis 1994;5(3):119-124. OBJECTIVE: To de termine the efficacy, safety and tolerance of cefcanel d a loxate and ph enoxymethylpenicillin (PcV) in the trealmen l of acule ph aryngo tonsillitis caused by bela-hemolytic streptococci group A (BHSGA). PATIENTS AND METHoos: Randomized, double-blind, multicentre sludy with subjects randomized 1: 1: 1: 1 lo four parallel trealmenl groups: cefcanel daloxale 150 mg bid. 300 mg b id, 600 mg daily and PcV 300 mg tid. Patients were treated for 10 days with clinical. bacteriological and safely evaluation al inclusion . during therapy (day 5), early after completion of therapy (day 14) and lwo weeks laler (day 28) . REsULTS: Of 340 subjects enrolled, 324 were valid for safely analysis and 249 for efficacy analysis. At the short term visit, clinical cure rales for cefcanel daloxale 300 mg bid and PcV groups were s imilar al approximately 70%. The cure rates for cefcanel daloxale 150 mg bid and 600 mg daily were significantly worse at 57.4 and 54.4%. Approximately 80% of all prethempy throal swabs grew BIISGA. All BHSGA were susceptible or intermediately susceptible to PcV and cefcanel. The bacteria l elimination rate for cefcanel daloxate was 82.8% and for PcV it was 89 .8%. The elimination rate was s ignificantly lower in the cefcanel daloxate 150 mg bid and 6 00 mg daily gro u ps. The clin ical cure rates and U1e bacteriological elimination rates increased by about 10% for cefcanel daloxate 300 mg bid and the PcV groups at the lasl valid visit and rem ained s ignificantly better than tl1e other two cefcanel daloxate doses. Adverse events were not significantly different among the four treain1enl groups. CONCLUSIONs: Cefcanel daloxate 300 mg b id was as effective and as well tolerated as PcV 300 mg tid in the treatment of acute pharyngotonsillitis. A lower dose or once-daily dose regimen of cefcanel daloxate was not as effective clinically or bacleriologically. (Pour resume. voir

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“…Cephalosporins result in fewer failures than PcV, which has been related to their better stability against betalactamases [7]. Eradication of the normal throat flora under therapy, in particular alpha-haemolytic streptococci, reported to have inhibitory activity against GAS, might increase the risk for failure [8].…”

Section: Introductionmentioning

confidence: 99%

Penicillin V, loracarbef and clindamycin in tonsillar surface fluid during acute group A streptococcal pharyngotonsillitis

Orrling

Kamme

Stjernquist-Desatnik

2005

Scandinavian Journal of Infectious Diseases

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A previously healthy 37-y-old male presented with community-acquired pneumonia and extensive upper limb deep vein thrombosis. The diagnosis of Legionella pneumonia was made based on a positive direct immunofluorescence of the bronchial wash. An extensive investigation for hypercoagulable states was negative. The possible association between Legionella infection and deep vein thrombosis is highlighted.

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Randomized, single-blind evaluation of cefadroxil and phenoxymethyl penicillin in the treatment of streptococcal pharyngitis

Cited by 43 publications

References 20 publications

Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis

Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis

Cefcanel Daloxate versus Penicillin in Acute Streptococcal Pharyngotonsillitis

Penicillin V, loracarbef and clindamycin in tonsillar surface fluid during acute group A streptococcal pharyngotonsillitis

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