SHORT-COURSE THERAPY WITH CEFUROXIME AXETIL FOR GROUP-A STREPTOCOCCALTONSILLOPHARYNGITIS IN CHILDREN

Background. Tonsillopharyngitis caused by group A beta-hemolytic strep tococci (GABHS) is common in pediatric clinical practice. Standard pen icillin therapy may be associated with poor compliance, penicillin tol erance in GABHS and microbial copathogenicity, Alternative treatments are available (e,g, oral cephalosporins), and data suggest that shorte r courses of these agents may be effective. Objective. This open, rand omized, multicenter study compared a conventional 10-day course of the broad spectrum oral cephalosporin, cefuroxime axetil, with a shorter B day course. Methods. Cefuroxime axetil suspension, 10 mg/kg, was giv en twice daily to children (ages 3 to 13 years) screened for GABHS ton sillopharyngitis. Patients were assessed clinically and bacteriologica lly 4 to 7 days after completing the course and followed up at 21 to 2 8 days. Among 651 patients recruited 520 had throat cultures positive for GABHS and were randomized to treatment. Results, In the 406 patien ts with microbiologically confirmed GABHS infection, eradication of th e initial pathogen was recorded in 177 of 201 (88%) and 189 of 205 (92 %) of patients in the 5- and l0-day groups, respectively, at posttreat ment. At follow-up, 137 of 162 (85%) of patients in the B day group an d 145 of 167 (87%) in the 10-day group maintained bacteriologic eradic ation, All posttreatment isolates of GABHS were susceptible to cefurox ime, and reinfection with a different serotype of GABHS was rare (less than or equal to 2%) in both groups. The rates of recurrence of the p retreatment serotype were 10 and 7% in the 5- and 10-day groups, respe ctively. Conclusions. Short course therapy with cefuroxime axetil susp ension may offer an effective alternative treatment to conventional re gimens, with potential for better compliance and reduced costs.