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Selections from Journal Watch Pediatrics and Adolescent medicine
Cephalosporins vs. penicillin for group A strep pharyngitis ▸
Penicillin is the most commonly recommended therapy for group A streptococcal (GAS) pharyngitis. Although group A streptococcus has not developed resistance, antibiotic therapy fails to eradicate the infection in some patients. Many authors have suggested using a cephalosporin as an alternative to penicillin. Casey and Pichichero performed a meta-analysis of 35 randomized, controlled trials comparing penicillin with cephalosporins in children.
Bacteriologic cure and clinical cure were both significantly more likely with the cephalosporins than with penicillin (odds ratios, 3.02 and 2.33, respectively). When the authors limited the analysis to trials with high quality scores, the difference in clinical cure rates was smaller; when only double-blind trials were considered, the treatments had equal clinical effect. The three generations of cephalosporins did not show different bacteriologic cure rates, though some agents performed better than others.
Comment ▸
This article demonstrates that cephalosporins have a higher cure rate than penicillin for the treatment of GAS pharyngitis. Other factors, however, must be considered in choosing the best therapy for a patient. Penicillin continues to have some advantages: It is the treatment with the narrowest antimicrobial spectrum, it is inexpensive, and it is well studied for the prevention of rheumatic fever. Of all the cephalosporins, only first-generation drugs should be considered for the treatment of GAS pharyngitis. The clearest advantage of cephalosporins is for patients in whom eradication of the organism is critical: those with frequent, recurrent, or complicated GAS infections.
Peggy Sue Weintrub, MD
Published in Journal Watch Pediatrics and Adolescent Medicine May 10, 2004
Planning ahead: advance emergency contraception for adolescents ▸
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