Comparison of cefdinir and penicillin for the treatment of streptococcal pharyngitis

Cefdinir, an oral cephalosporin active against Streptococcus pyogenes (grou p A beta-hemolytic streptococci [GABHS]), is also resistant to degradation by most oropharyngeal beta-lactamases. This multicenter, randomized, contro lled, double-masked study assessed the tolerability and efficacy of 2 dosin g regimens of cefdinir in the treatment of pharyngitis due to GABHS. Adults and adolescents with pharyngitis due to GABHS received cefdinir 600 mg QD, cefdinir 300 mg BID, or penicillin V 250 mg QID each for 10 days. A throat culture and clinical assessment were obtained 4 to 9 days after completion of therapy. Of 919 patients enrolled, 644 (70.1%) were microbiologically a ssessable. The eradication rates 4 to 9 days after completion of therapy we re 91.4% in the cefdinir QD group, 91.7% in the cefdinir BID group, and 83. 4% in the penicillin group (P = 0.02 for cefdinir QD vs penicillin, P = 0.0 1 for cefdinir BID vs penicillin, P = 0.95 for cefdinir QD vs cefdinir BID) . Clinical cure rates were also superior with cefdinir QD (94.8%, P = 0.02) and cefdinir BID (96.3%, P < 0.01) compared with penicillin (88.9%). Diarr hea was more common in the cefdinir groups (P less than or equal to 0.001). Seventeen cefdinir patients and 4 penicillin patients discontinued therapy because of adverse reaction (P = 0.13). Ten days of treatment for streptoc occal pharyngitis with cefdinir QD or BID is superior to treatment with pen icillin V for the eradication of GABHS from the pharynx, although it is ass ociated with a higher rate of adverse reactions.