COMPARISON OF CLARITHROMYCIN AND PENICILLIN VK SUSPENSIONS IN THE TREATMENT OF CHILDREN WITH STREPTOCOCCAL PHARYNGITIS AND REVIEW OF CURRENTLY AVAILABLE ALTERNATIVE ANTIBIOTIC THERAPIES

In a randomized investigator-blinded study, 506 children ages 6 months to 12 years with positive rapid direct antigen tests for Group A beta -hemolytic Streptococcus (GABHS) received treatment with either clarit hromycin suspension, 7.5 mg/kg twice daily, or penicillin VK suspensio n, 13.3 mg/kg three times per day for 10 days. Signs and symptoms of p haryngitis or tonsillitis were evaluated and throat cultures were obta ined before treatment, once during treatment and 4 to 6 days and 19 to 25 days posttreatment. All GABHS isolates were susceptible in vitro t o clarithromycin. Successful clinical responses at the end of treatmen t were demonstrated in 169 of 176 (96%) evaluable clarithromycin-treat ed patients and 179 of 191 (94%) evaluable penicillin-treated patients . GABHS was successfully eradicated at end of treatment in 168 of 183 (92%) evaluable clarithromycin-treated patients compared with 162 of 1 99 (81%) evaluable penicillin-treated patients (P = 0.004). There were no significant changes in hematologic or serum chemistry parameters i n either group. Both drugs were well-tolerated. The incidence and natu re of adverse events were similar in the clarithromycin and penicillin groups, except for gastrointestinal complaints reported in 35 of 250 (14%) clarithromycin recipients compared with 12 of 256 (5%) penicilli n recipients (P less than or equal to 0.001). The results indicate tha t twice daily clarithromycin was as safe and effective as three times daily penicillin VK in the treatment of children with streptococcal ph aryngitis or tonsillitis. Clarithromycin was statistically superior to penicillin VK in the eradication of GABHS.