THE EFFECT OF ERYTHROMYCIN ON RESOLUTION OF SYMPTOMS AMONG ADULTS WITH PHARYNGITIS NOT CAUSED BY GROUP-A STREPTOCOCCUS

OBJECTIVE: To determine the effect of treatment with erythromycin on t he resolution of symptoms among adults with pharyngitis not caused by group A streptococcus (GAS). DESIGN: Randomized, double-blind, placebo -controlled trial. SETTING: Ambulatory setting (hospital-based general inter nal medicine practices, walk-in clinic, employee health service , and university health service). PATIENTS: One hundred and eighty-six adults who met eligibility criteria and whose chief complaint include d sore throat. Patients with positive cultures for GAS were excluded. INTERVENTION Ninety-three patients received erythromycin (333 mg three times daily for 10 days) and 93 control patients received placebo. ME ASUREMENTS AND MAIN RESULTS: Major outcome measurements included time to improvement in sore throat, time to improvement in cough, time to i mprovement in activity level, and subjective sense of well-being. The average age of the patients studied was 26.6 years; 35% were men. Pati ents given erythromycin had more rapid resolution of sore throat sympt oms (hazard ratio 1.43; 95% confidence interval [CI] 1.00, 2.03: p = . 049). Cough also resolved more rapidly in patients receiving erythromy cin (hazard ratio 2.22; 95% CI 1.01, 4.88; p = .05). There were no dif ferences between the two treatment groups in improvement of activity l evel or how sick patients felt in general. Most of the benefit in reso lution of sore throat was conferred on patients who sought medical car e within 2 days of onset. CONCLUSIONS: Our results suggest that the be nefit of erythromycin treatment for patients with non-GAS pharyngitis is small and of borderline statistical significance. Because of the sm all size of the effect and because widespread use of erythromycin coul d promote drug resistance, we do not recommend routine use of erythrom ycin in adult patients with this type of pharyngitis.