Macrolide therapy of group A streptococcal pharyngitis: 10 days of macrolide therapy (clarithromycin) is more effective in streptococcal eradication than 5 days (azithromycin)
El. Kaplan et al., Macrolide therapy of group A streptococcal pharyngitis: 10 days of macrolide therapy (clarithromycin) is more effective in streptococcal eradication than 5 days (azithromycin), CLIN INF D, 32(12), 2001, pp. 1798-1802
We compared recommended doses of 2 oral macrolide antibiotics (10 days of c
larithromycin, 5 days of azithromycin) for eradicating group A streptococci
from the throats of individuals aged greater than or equal to 12 years wit
h symptomatic pharyngitis and a positive throat culture. Patients received
either clarithromycin (250 mg b.i.d. for 10 days [n = 260]) or azythromycin
(500 mg on day 1, followed by 250 mg q.d. for 4 days [n = 265]). Follow-up
throat cultures were obtained both at 13-19 days and at 28-38 days. We eva
luated 392 patients (median age, 26 years; clarithromycin, 194 patients; az
yithromycin, 198 patients). Ten days of clarithromycin therapy was more eff
ective than 5 days of azithromycin therapy in eradicating the organism (91%
[176/194] vs. 82% [162/198]; P = .012). More than 97% of all streptococcal
isolates were macrolide-sensitive. Whether these bacteriologic eradication
rates were the result of the 2 macrolides compared or were due to differen
ces in duration of therapy could not be determined, but the statistically s
ignificant difference in eradication of group A streptococci does raise add
itional questions about shortened courses of macrolide therapy for this com
mon infection.