Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults

Objective To assess whether treatment with penicillin for three days and th e traditional treatment for seven days were equally as effective at acceler ating resolution of symptoms in patients with sore throat compared with pla cebo. Design Randomised double blind placebo controlled trial. Setting 43 family practices in the Netherlands. Participants 561 patients, aged 15-60 years, with sore throat for less than seven days and at least three of four Center criteria-that is, history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate. 142 patients were excluded for medical reasons and 73 ne eded penicillin. Interventions Patients were randomly assigned to penicillin V for seven day s, penicillin V for three days followed by placebo for four days, or placeb o for seven days. Main outcome measures Resolution of symptoms in the first week, eradication of bacteria after two weeks, and recurrences of sore throat after two, fou r, and six months. Results Symptoms resolved 1.9 and 1.7 days earlier patients taking penicill in for seven days than in those taking penicillin for three days or placebo Symptoms resolved 2.5 days earlier in patients with group A streptococci a nd 1.3 days earlier in patients with high colony counts of non-group A stre ptococci. 23 (13%) of the placebo group had to be given antibiotics later i n the week because of clinical deterioration; three developed a peritonsill ar abscess. The eradication rate for group A streptococci was 72% in the se ven day penicillin group, 41% in the three day penicillin group, and 7% in the placebo group. Sore throat recurred more often in the three day penicil lin group than in the seven day penicillin or placebo groups. Conclusion Penicillin treatment for seven days was superior to treatment fo r three days or placebo in resolving symptoms of sore throat in patients wi th group A streptococcal pharyngitis and, possibly, in those with non-group A streptococcal pharyngitis.