Clarithromycin suspension vs penicillin V suspension in children with streptococcal pharyngitis

Clarithromycin, an advanced-generation macrolide antibiotic, has demonstrat ed excellent in vitro activity against group A beta-hemolytic streptococcus (GABHS). Potent activity against Streptococcus pyogenes and a favorable ph armacokinetic profile have made it a reasonable alternative for treatment o f patients with streptococcal pharyngitis. The safety and efficacy of clari thromycin and penicillin V were compared in a randomized, investigator-blin d study. Children 6 months to 12 years of age received 5 days of clarithrom ycin suspension 7.5 mg/kg twice daily (n = 268) or 10 days of penicillin V suspension 13.3 mg/kg three times daily (n = 260). Patients were evaluated for signs and symptoms of pharyngitis, and throat swabs for culture were ob tained prior to therapy, at the end of therapy, and at follow-up. Clarithro mycin and penicillin V produced comparable rates of clinical success (cure + improvement) at the posttreatment (97% and 94%) and follow-up (81% and 82 %) evaluations. The GABHS eradication rate, however, was significantly high er with clarithromycin (94% vs 78%, P<.001). Both drugs were well tolerated ; gastrointestinal complaints were similar and mild. Resistance did not occ ur with the short course of clarithromycin or the standard regimen of penic illin V. Five days' treatment with clarithromycin was superior to 10 days o f penicillin in eradicating S. pyogenes.