Treatment of Streptococcal Pharyngitis With Once-Daily Amoxicillin Versus Intramuscular Benzathine Penicillin G in Low-Resource Settings: A Randomized Controlled Trial

Abstract

Background: Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β-hemolytic streptococcal (GAS) pharyngitis. Methods: To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia. Results: A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (−9.3% difference). Conclusion: If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.

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

“…A previous study by Rimoin et al (2011) found that oral amoxicillin treatment was inferior to IM penicillin treatment in Egyptian children with poor compliance of (30.1%), and of comparable efficacy in Croatian children of good compliance (84.4%), suggesting IM BPG should be preferred where compliance is a major concern [49]. However in our study, compliance was not an issue with treatment regimens, as parents/guardians of children in the amoxicillin group were strongly stressed on the importance of administering the antibiotic at the same time every day for 10 days each month.…”

“…However, even if the oral therapy seems to be the preferable choice, the major driver of its success remains proper compliance, where several studies have correlated treatment failures to non-adherent patients [49].…”

Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections

“…Compared with injectable antibiotics, oral antibiotics are associated with fewer complications, less severe hypersensitivity reactions, and no pain at the injection site; however, drug compliance may be a problem [ 12 60 ]. Therefore, IM benzathine penicillin G may be used for patients deemed to have difficulty complying with a 10-day oral antibiotic regimen [ 12 60 61 ]. Studies have found no significant differences in the clinical efficacy of 10-day amoxicillin oral antibiotic therapy and single IM injection of benzathine penicillin G [ 61 62 ].…”

“…Therefore, IM benzathine penicillin G may be used for patients deemed to have difficulty complying with a 10-day oral antibiotic regimen [ 12 60 61 ]. Studies have found no significant differences in the clinical efficacy of 10-day amoxicillin oral antibiotic therapy and single IM injection of benzathine penicillin G [ 61 62 ].…”

Comparing performance of amoxicillin and intramuscular benzathine penicillin in relieving manifestations of <i>Streptococcal pharyngitis</i> in children

“…Many studies have shown that amoxicillin taken once a day may be as effective as oral penicillin V. There had been trials about once-daily therapy for strep throat with amoxicillin. [6][7][8] We aimed to compare efficacy of once-daily orally amoxicillin and BPG in relieving various clinical manifestations and their bacteriologic response to the pharyngitis.…”