Analysis of clarithromycin and propicillin in the management of streptococcal pharyngotonsillitis in children

Objective: To compare the clinical and bacteriological efficacy and safety of clarithromycin and propicillin in the treatment of streptococcal pharyng otonsillitis in children. Design: This was a prospective, non-blind, longitudinal, comparative study. All patients included were randomised to receive either clarithromycin or propicillin. Setting: Participants were outpatients attending a private paediatric clini c in Celaya, Guanajuato, Mexico. Patients: Patients aged between 1 and 15 years presenting with signs and sy mptoms of pharyngotonsillitis were enrolled in this study. Interventions and Outcome Measures: The dosage of clarithromycin was 15 mg/ kg/day divided into two daily doses, and for propicillin it was 25 000 U/kg /day divided into three daily doses. Both drugs were given for 10 days. Pat ients were evaluated according to resolution of signs and symptoms, and adv erse events. Pharyngeal cultures were collected at the initial office visit s and 3 days after the conclusion of drug therapy. Data were analysed using the Epi5 computer program and chi(2) tests were performed regarding time t o resolution of clinical signs, adverse events and bacteriologoical cure. Results: Of the 387 patients presenting with signs of pharyngotonsillitis, 189 were culture positive. A total of 102 were randomised to receive clarit hromycin and 87 to receive propicillin. A statistically significant differe nce in resolution of clinical signs at 48 hours after initiation of treatme nt was found in favour of clarithromycin for dysphagia (chi(2) = 59.21; p < 0.00001), pharyngeal erythema (chi(2) = 61.48; p < 0.00001) and pharyngeal exudate (chi(2) = 103.61; p < 0.00001). Statistically significant differen ces in favour of clarithromycin were also seen on days 5, 7 and 9 of treatm ent for all these signs. Bacteriological efficacy tended to be higher with clarithromycin [relative rate for bacteriological success with clarithromyc in = 1.11; confidence interval = 1.00 to 1.24; chi(2) (Yates)= 3.05; p = 0. 08]; these differences were not significant. 11 patients would need to be t reated with clarithromycin to yield bacteriological success in 1 additional patient. Clarithromycin showed a lower overall rate of adverse events, but abdominal pain and nausea were more common with this agent. Conclusions: Clarithromycin is an excellent alternative in the treatment of streptococcal pharyngotonsillitis in children because of its higher clinic al (95% vs 86% of propicillin) and bacteriological (92% vs 82% of propicill in) efficacy and the faster rate of improvement than with propicillin.