Cefuroxime axetil in short-course therapy of tonsillopharyngitis - A pooled analysis of 3308 patients receiving 5-or 10-day treatments compared with 10-day oral penicillin V

Background: Although 10 days' treatment with oral penicillin V has been the standard recommended treatment for Group A beta-haemolytic streptococcal ( GABHS) tonsillopharyngitis for the last 40 years, shorter penicillin course s are not as effective.. In contrast, short-course treatments with newer ag ents have been shown to be effective and to have similar efficacy to penici llin in preventing poststreptococcal sequelae. Objective: To assess treatment outcomes and benefits of different durations of cefuroxime axetil therapy compared with a 10-day penicillin V regimen i n streptococcal tonsillopharyngitis. Methods: Literature searches (1987 to present) were undertaken to identify comparative studies of cefuroxime axetil versus penicillin V in the treatme nt of tonsillopharyngitis. Results: Four studies, involving 1042 GABHS culture-positive patients in th e USA, compared cefuroxime axetil twice daily for 10 days (n = 682 patients ) with penicillin V three times daily for 10 days (n = 360 patients). Resul ts of a pooled analysis indicated that GABHS eradication was superior in th e patients treated with cefuroxime axetil (94%; 640/682) compared with thos e receiving penicillin (85%; 305/360). The weight-adjusted treatment differ ence of 9% [95% confidence intervals (CI) 4.3 to 13.7%] was significant in favour of cefuroxime axetil (odds ratio of successful treatment 2.7 relativ e to penicillin). Clinically there was also a significant treatment differe nce of 6.8% (95% CI 2.4 to 11.2%). Three European studies (n = 2266) compar ed 4- to 5-day cefuroxime axetil treatment with 10 days' penicillin V in cu lture-positive tonsillopharyngitis. In the pooled analysis, eradication rat es were 90% (604/668) for cefuroxime axetil compared with 85% (1357/1598) f or penicillin V. The weight-adjusted treatment difference was 3.4% (95% CI -0.7 to 7.4%), indicating superiority of cefuroxime axetil treatment. Conclusions: Pooled analyses confirmed the results of individual studies an d highlighted the superiority of cefuroxime axetil given for 10 days or 4 t o 5 days over 10 days' penicillin V, both in the treatment of acute culture -proven tonsillopharyngitis. importantly short-course cefuroxime axetil is superior to the standard oral penicillin regimen. With increasing concerns about antibacterial usage, shorter treatment courses in this indication cou ld be beneficial and used as alternatives to the penicillin reference treat ment.