EVALUATION OF SHORT-COURSE THERAPY WITH CEFIXIME OR RIFAMPIN FOR ERADICATION OF PHARYNGEALLY CARRIED GROUP-A STREPTOCOCCI

Therapy to eradicate pharyngeally carried group A streptococci (GAS) h as increasingly been used in the management of institutional outbreaks and is now recommended for household contacts of patients with strept ococcal toxic shock syndrome. In this randomized, controlled trial, co ntacts of patients with GAS infections were screened for pharyngeal GA S colonization. Those whose cultures were positive were randomized to receive either cefixime (8 mg/[kg . d]; maximum 400 mg) or rifampin (2 0 mg/kg; maximum, 600 mg) once a day for 4 days. Two to five days foll owing completion of therapy, repeated cultures were negative for 13 (3 8%) of 34 rifampin recipients and 71 (77%; 95% CI, 69%-85%) of 97 cefi xime recipients. At 10-14 days after treatment, only 53% of cefixime r ecipients remained culture-negative. Rates of successful clearance imp roved with increasing age (P < .01); among 17 adults who received cefi xime, the success rate was 94%, Four days of therapy with rifampin is not effective for eradication of pharyngeally carried GAS. Four days o f therapy with cefixime may be effective for adults, but further studi es are needed.