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Different antibiotic treatments for group A streptococcal pharyngitis

Mieke L van Driel, An De Sutter UGent, Natalija Keber, Hilde Habraken and Thierry Christiaens UGent (2010) COCHRANE DATABASE OF SYSTEMATIC REVIEWS.
abstract
Background: Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. Objectives: We assessed the comparative efficacy of different antibiotics on clinical outcomes, relapse, complications and adverse events in GABHS tonsillopharyngitis. Search strategy: We searched The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3) which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to July Week 4, 2010) and EMBASE (1974 to August 2010). Selection criteria: Randomised, double-blind trials comparing different antibiotics reporting at least one of the following: clinical cure, clinical relapse, complications, adverse events. Data collection and analysis: Two authors independently screened trials for inclusion and extracted data. Main results: Seventeen trials (5352 participants) were included; 16 compared with penicillin (six with cephalosporins, six with macrolides, three with carbacephem and one with sulfonamides), one trial compared clindamycin and ampicillin. Randomisation reporting, allocation concealment and blinding were poor. There was no difference in symptom resolution between cephalosporins and penicillin (intention-to-treat (ITT) analysis; N = 5; n = 2018; odds ratio for absence of resolution of symptoms (OR) 0.79, 95% confidence interval (CI) 0.55 to 1.12). Clinical relapse was lower with cephalosporins (N = 4; n = 1386; OR 0.55, 95% CI 0.31 to 0.99); overall number needed to treat to benefit (NNTB) 50), but found only in adults (OR 0.42, 95% CI 0.20 to 0.88; NNTB 33). There were no differences between macrolides and penicillin. Carbacephem showed better symptom resolution post-treatment (N = 3; n = 795; OR 0.70, 95% CI 0.49 to 0.99; NNTB 14), but only in children (N = 2; n = 233; OR 0.57, 95% CI 0.33 to 0.99; NNTB 8.3). Children experienced more adverse events with macrolides (N = 1, n = 489; OR 2.33; 95% CI 1.06 to 5.15). Authors' conclusions: Evidence is insufficient for clinically meaningful differences between antibiotics for GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be recommended as first choice.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
RANDOMIZED CONTROLLED-TRIAL, CEFUROXIME AXETIL, BETA-HEMOLYTIC STREPTOCOCCI, 5-DAY CEFDINIR TREATMENT, SHORT-COURSE THERAPY, PENICILLIN-V, SORE THROAT, RHEUMATIC-FEVER, COMPARATIVE EFFICACY, PHENOXYMETHYL PENICILLIN
journal title
COCHRANE DATABASE OF SYSTEMATIC REVIEWS
Cochrane Database Syst Rev.
issue
10
article number
CD004406
pages
66 pages
Web of Science type
Review
Web of Science id
000282589800008
JCR category
MEDICINE, GENERAL & INTERNAL
JCR impact factor
6.186 (2010)
JCR rank
10/151 (2010)
JCR quartile
1 (2010)
ISSN
1469-493X
DOI
10.1002/14651858.CD004406.pub2
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1253366
handle
http://hdl.handle.net/1854/LU-1253366
date created
2011-06-06 14:36:09
date last changed
2016-12-21 15:41:57
@article{1253366,
  abstract     = {Background: Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. Objectives: We assessed the comparative efficacy of different antibiotics on clinical outcomes, relapse, complications and adverse events in GABHS tonsillopharyngitis. Search strategy: We searched The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3) which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to July Week 4, 2010) and EMBASE (1974 to August 2010). Selection criteria: Randomised, double-blind trials comparing different antibiotics reporting at least one of the following: clinical cure, clinical relapse, complications, adverse events. Data collection and analysis: Two authors independently screened trials for inclusion and extracted data. Main results: Seventeen trials (5352 participants) were included; 16 compared with penicillin (six with cephalosporins, six with macrolides, three with carbacephem and one with sulfonamides), one trial compared clindamycin and ampicillin. Randomisation reporting, allocation concealment and blinding were poor. There was no difference in symptom resolution between cephalosporins and penicillin (intention-to-treat (ITT) analysis; N = 5; n = 2018; odds ratio for absence of resolution of symptoms (OR) 0.79, 95\% confidence interval (CI) 0.55 to 1.12). Clinical relapse was lower with cephalosporins (N = 4; n = 1386; OR 0.55, 95\% CI 0.31 to 0.99); overall number needed to treat to benefit (NNTB) 50), but found only in adults (OR 0.42, 95\% CI 0.20 to 0.88; NNTB 33). There were no differences between macrolides and penicillin. Carbacephem showed better symptom resolution post-treatment (N = 3; n = 795; OR 0.70, 95\% CI 0.49 to 0.99; NNTB 14), but only in children (N = 2; n = 233; OR 0.57, 95\% CI 0.33 to 0.99; NNTB 8.3). Children experienced more adverse events with macrolides (N = 1, n = 489; OR 2.33; 95\% CI 1.06 to 5.15). Authors' conclusions: Evidence is insufficient for clinically meaningful differences between antibiotics for GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be recommended as first choice.},
  articleno    = {CD004406},
  author       = {van Driel, Mieke L and De Sutter, An and Keber, Natalija and Habraken, Hilde and Christiaens, Thierry},
  issn         = {1469-493X},
  journal      = {COCHRANE DATABASE OF SYSTEMATIC REVIEWS},
  keyword      = {RANDOMIZED CONTROLLED-TRIAL,CEFUROXIME AXETIL,BETA-HEMOLYTIC STREPTOCOCCI,5-DAY CEFDINIR TREATMENT,SHORT-COURSE THERAPY,PENICILLIN-V,SORE THROAT,RHEUMATIC-FEVER,COMPARATIVE EFFICACY,PHENOXYMETHYL PENICILLIN},
  language     = {eng},
  number       = {10},
  pages        = {66},
  title        = {Different antibiotic treatments for group A streptococcal pharyngitis},
  url          = {http://dx.doi.org/10.1002/14651858.CD004406.pub2},
  year         = {2010},
}

Chicago
van Driel, Mieke L, An De Sutter, Natalija Keber, Hilde Habraken, and Thierry Christiaens. 2010. “Different Antibiotic Treatments for Group A Streptococcal Pharyngitis.” Cochrane Database of Systematic Reviews (10).
APA
van Driel, M. L., De Sutter, A., Keber, N., Habraken, H., & Christiaens, T. (2010). Different antibiotic treatments for group A streptococcal pharyngitis. COCHRANE DATABASE OF SYSTEMATIC REVIEWS, (10).
Vancouver
1.
van Driel ML, De Sutter A, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. COCHRANE DATABASE OF SYSTEMATIC REVIEWS. 2010;(10).
MLA
van Driel, Mieke L, An De Sutter, Natalija Keber, et al. “Different Antibiotic Treatments for Group A Streptococcal Pharyngitis.” COCHRANE DATABASE OF SYSTEMATIC REVIEWS 10 (2010): n. pag. Print.