Variables Influencing Penicillin Treatment Outcome in Streptococcal Tonsillopharyngitis

Abstract

To examine whether penicillin treatment success for group A ␤-hemolytic streptococcal tonsillopharyngitis is influenced by patient age, number of days ill prior to initiation of treatment, number of prior episodes, season, total dosage (milligrams per kilogram), and frequency of administration (2 vs 3 times daily). Methods: Four hundred seventy-eight children, adolescents, and young adults aged 2 to 21 years with acute symptoms compatible with the clinical diagnosis of group A ␤-hemolytic streptococcal tonsillopharyngitis and a positive streptococcus rapid antigen detection test result were enrolled (intent-to-treat group). Patients were randomly assigned to receive penicillin V potassium, 250 mg 3 times daily (n = 239) or 500 mg 2 times daily (n = 239). Randomization was independent of patient body weight and treatment was for 10 days with both regimens. Follow-up examinations occurred, and cultures were obtained at 14 to 21 days after the initiation of antibiotic therapy; those with group A ␤-hemolytic strep-tococcus isolated from a throat culture and who returned for follow-up were assessed for outcome (n = 359). Results: Using a logistic regression analysis with a stepwise variable selection, we found the major variables associated with penicillin treatment success to be the number of days ill prior to initiation of treatment (P = .001; odds ratio, 1.55 [95% confidence interval, 1.2-2.1]) and the age of the child when infected (P = .004; odds ratio, 1.14 [95% confidence interval, 1.05-1.25]). The number of prior episodes within the preceding year, the season, the total daily penicillin dose (range, 8-76 mg/kg), and 2 vs 3 times daily dosing did not significantly alter treatment outcome. Conclusion: Treatment after 2 days of illness and of adolescent patients increases penicillin treatment success for group A ␤-hemolytic streptococcal tonsillopharyngitis.

Compliance with Once-Daily versus Twice or Thrice-Daily Administration of Antibiotic Regimens: A Meta-Analysis of Randomized Controlled Trials

“…Amoxicillin/clavulanic acid was the most commonly administered penicillin. [ 6 , 13 , 16 , 17 , 21 , 22 , 24 ] Twenty-two studies referred to respiratory tract infections (8 tonsillopharyngitis,[ 8 – 10 , 15 , 18 , 23 , 29 , 31 ] 5 acute otitis media,[ 13 , 17 , 22 , 24 , 28 ] 3 lower respiratory tract infections,[ 6 , 16 , 25 ] 1 sinusitis,[ 19 ] and 5 undetermined respiratory tract infections[ 7 , 11 , 20 , 21 , 27 ]), two studies to urinary tract infections[ 14 , 30 ] and the remaining 2 to skin infections. [ 12 , 26 ]…”

Variables influencing bacteriological outcome in patients with streptococcal tonsillopharyngitis treated with penicillin V

“…This regimen has several advantages: despite 50 years use of penicillin, group A b-haemolytic streptococci remain susceptible, it is the only one which has proven the ability to prevent acute rheumatic fever, and finally, adverse effects are uncommon [10]. In this [9], who found that the risk of failure was significantly higher in children aged 3-5 years than in older children. The small number of children with an interval of less than 2 days between symptom onset and treatment initiation in this study prevented us from drawing firm conclusions on the influence of this factor.…”

How Do You Improve Compliance?

“…Data support this notion in the primary care setting; however, an effect on compliance has not been noted consistently. 26,[37][38][39][40][41][42][43][44] A recent survey of caregivers for children with HIV failed to show a difference in compliance on the basis of the number of medications prescribed, although factors related to simplifying the medication regimen were cited by parents as a significant means to enhance adherence in this and another study. 45,46 Forms Medications are administered in a variety of forms, including liquid, suspension, powder, tablet, capsule, topical creams, and topical patches.…”