Cephalexin and penicillin in the treatment of group A beta-hemolytic streptococcal throat infections
F. A. Disney, H. Dillon, J. L. Blumer, B. A. Dudding, S. E. McLinn, D. B. Nelson and S. M. Selbst
Department of Pediatrics, Elmwood Pediatric Group, Rochester, NY.
OBJECTIVE--To determine whether cephalexin or penicillin is more effective
in the treatment of group A beta-hemolytic streptococcal
tonsillopharyngitis in children. DESIGN--Randomized, double-blind,
crossover study conducted from 1981 to 1984. SETTING--Seven pediatric
practices in the United States, including private offices and pediatric
clinics. PARTICIPANTS--Of the 654 patients, 525 children and adolescents
with clinical evidence of tonsillitis or pharyngitis and throat cultures
positive for group A beta-hemolytic streptococcal infection were evaluable.
Eighty percent of patients completed the study; none were withdrawn because
of adverse reaction. SELECTION CRITERIA--Children and adolescents who had
acute illness suggestive of group A beta-hemolytic streptococcal infection
were enrolled in the study. Treatment was continued if the throat culture
was positive for group A beta-hemolytic streptococcal infection.
INTERVENTIONS--Four doses of cephalexin and penicillin (27 mg/kg per day)
were prescribed to be taken on an empty stomach for 10 days.
MEASUREMENTS/MAIN RESULTS--Symptomatic clinical failure occurred in 8% of
penicillin-treated patients and in 3% of cephalexin-treated patients.
Bacteriologic failure rates were 11% in the penicillin treatment group and
7% in the cephalexin treatment group. The combined treatment failure rate
of clinical relapse plus asymptomatic bacteriologic failure was 19% in the
penicillin treatment group and 10% in the cephalexin treatment group.
Paired antistreptolysin-O titer increased significantly in 62.3% of
penicillin-treated patients and in 64.2% of cephalexin-treated patients.
Similarly, anti-DNase B titers rose 52.2% in penicillin-treated patients
and 52.4% in cephalexin-treated patients. CONCLUSION--Cephalexin is a more
effective drug than penicillin in the treatment of group A beta-hemolytic
streptococcal throat infection in children.
Pharmacodynamic Analysis and Clinical Trial of Amoxicillin Sprinkle Administered Once Daily for 7 Days Compared to Penicillin V Potassium Administered Four Times Daily for 10 Days in the Treatment of Tonsillopharyngitis Due to Streptococcus pyogenes in Children
Pichichero et al.
Antimicrob. Agents Chemother. 2008;52:2512-2520.
ABSTRACT
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Frequency of Symptomatic Relapses of Group A {beta}-Hemolytic Streptococcal Tonsillopharyngitis in Children From 4 Pediatric Practices Following Penicillin, Amoxicillin, and Cephalosporin Antibiotic Treatment
Casey et al.
CLIN PEDIATR 2008;47:549-554.
ABSTRACT
The Importance of Bacteriologic Eradication in the Treatment of Group A Streptococcal Tonsillopharyngitis
Pichichero
CLIN PEDIATR 2007;46:3S-16S.
ABSTRACT
Selecting the Optimal Antibiotic in the Treatment of Group A {beta}-Hemolytic Streptococci Pharyngitis
Casey
CLIN PEDIATR 2007;46:25S-35S.
ABSTRACT
Meta-analysis of Cephalosporin Versus Penicillin Treatment of Group A Streptococcal Tonsillopharyngitis in Children
Casey and Pichichero
Pediatrics 2004;113:866-882.
ABSTRACT
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Efficacy of Cephalexin Two vs. Three Times Daily vs. Cefadroxil Once Daily for Streptococcal Tonsillopharyngitis
Curtin et al.
CLIN PEDIATR 2003;42:519-526.
ABSTRACT
Diagnosis and treatment of streptococcal sore throat
DTB 1995;33:9-12.
ABSTRACT
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CEPHALEXIN SUPERIOR TO PENICILLIN FOR STREP THROAT
JWatch General 1992;1992:4-4.
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