Comparison of short-course (5 day) cefuroxime axetil with a standard 10 day oral penicillin V regimen in the treatment of tonsillopharyngitis

Oral penicillin V given three times daily in doses of 50,000-100,000 IU dai ly has been the standard treatment for tonsillopharyngitis for the last few decades. These regimens, initially recommended by the American Heart Assoc iation, were extrapolated from iv dosing with long-acting forms of penicill in which had been shown to prevent post-streptococcal sequelae. More recent ly, several antibiotics, including cefuroxime axetil, have been shown to be at least as effective as penicillin G in eradicating group A beta-haemolyt ic streptococci (GABHS) but their influence on post-streptococcal sequelae has never been assessed in a large-scale trial. The German Society for Pedi atric Infectious Diseases (DGPI) undertook a large study of culture-proven tonsillopharyngitis involving several agents and included a 1 year follow-u p to establish the effect on sequelae. In one arm of this study, cefuroxime 250 mg bid was compared with 50,000 IU penicillin V given in three divided doses. Cefuroxime axetil was more effective than oral penicillin V in erad icating GABHS at the assessment 2-4 days post-treatment (441/490 (90%) pati ents versus 1196/1422 (84%) patients; P = 0.001). Clinically, the two agent s were equivalent in efficacy, and carriage rates were similar (11.1% and 1 3.8%, respectively) in patients receiving cefuroxime axetil and penicillin V, 7-8 weeks post-treatment. One case of glomerular nephritis occurred in a patient given penicillin V. There were no post-streptococcal sequelae conf irmed for patients treated with cefuroxime axetil. The findings confirm the previously reported efficacy of short-course (4-5 day) treatments with cef uroxime axetil and indicate that short-course treatment is comparable to th e standard oral penicillin V regimen in preventing post-streptococcal seque lae.