EFFECTIVE SHORT-COURSE TREATMENT OF ACUTE GROUP-A BETA-HEMOLYTIC STREPTOCOCCAL TONSILLOPHARYNGITIS

Objective: To compare bacteriologic and clinical efficacy and safety o f 10 vs 5 days of cefpodoxime proxetil vs 10 days of penicillin V pota ssium for the treatment of acute group A beta-hemolytic streptococcal tonsillopharyngitis in children. Design: Prospective, randomized, obse rver-blind, multicenter study. Patients/lnterventions: Four hundred ei ghty-four children (age range, 2 to 17 years) with signs and symptoms of acute tonsillopharyngitis were enrolled; 377 had a positive throat culture for group A beta-hernolytic streptococci and were fully evalua ble. One hundred twenty-one patients received cefpodoxime once a day f or 10 days, 126 received cefpodoxime twice a day for 5 days, and 130 r eceived penicillin V three times a day for 10 days. Results: Cefpodoxi me for 10 days vs cefpodoxime for 5 days vs penicillin V for 10 days p roduced bacteriologic eradication at the end of therapy in 95%, 90%, a nd 78% of the patients, respectively. The 10- and 5-day cefpodoxime tr eatment regimens were more efficacious than penicillin V (P = .003 and P = .02, respectively). The cumulative bacteriologic failure rate amo ng assessable patients by the 32- to 38-day posttreatment visit was 20 (17%) of 121 patients who were treated Tnith cefpodoxime for 10 days, 24 (19%) of 125 patients who were treated with cefpodoxime for 5 days , and 45 (35%) of 130 patients who were treated with penicillin V for 10 days (P = .001 and P = .005, respectively). Clinical cure or improv ement was observed at the end of therapy in 96%, 94%, and 91% of the p atients, respectively (P = not significant). Adverse events were infre quent and similar in all three treatment groups, with minor gastrointe stinal side effects predominating. Conclusions: Five days of treatment with cefpodoxime is as efficacious in bacteriologic eradication and c linical response (cure plus improvement) as 10 days of cefpodoxime the rapy, and both cefpodoxime regimens produced superior bacteriologic ef ficacy compared with a 10-day regimen of penicillin V in the treatment of group A beta-hemolytic streptococcal tonsillopharyngitis in childr en.