s-1108 and Tonsillitis

Group A streptococcal (GAS) tonsillopharyngitis is one of the few conditions for which antibiotics are advocated among common upper respiratory infections. Although a 3-day course of azithromycin is attracting attention as a treatment of choice for the condition, it is not clear if the efficacy of the treatment is comparable with that of treatment with cephalosporins. A prospective, randomized, comparative multicenter study was conducted to compare the efficacy of azithromycin (AZM) given once daily for 3 days with that of cefcapene-pivoxyl (CFPN-PI) divided into three daily doses for 5 days. 88 patients (male: 38, mean age: 16.5) were treated with AZM and 69 (male: 34, mean age: 16.9) with CFPN-PI. The symptoms of all but 5 (2 for AZM and 3 for CFPN-PI) of the patients were resolved by the 8th day of the treatment. By the 4th day of the treatment, criteria for clinical efficacy were fulfilled in 71 (80.7%) subjects who were treated with AZM and in 48 (67.6%) of those treated with CFPN-PI (p = 0.07). The same figures on the 8th day of the treatment were 86 (97.7%) and 68 (95.8%), respectively (p = 0.66), confirming there was no significant difference in clinical efficacy between the two treatments. Mild adverse reactions were reported by two patients treated with AZM and by none treated with CFPN-PI. The clinical efficacy of a 3-day course with AZM was comparable with that of a 5-day course of CFPN-PI for GAS tonsillopharyngitis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Cephalosporins; Chi-Square Distribution; Drug Administration Schedule; Female; Humans; Male; Microbial Sensitivity Tests; Pharyngitis; Prospective Studies; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome; Young Adult

We prospectively compared the efficacy of oral cefditoren-pivoxil and conventional oral amoxicillin for pharyngotonsillitis caused by group A streptococcus in children. Either oral cefditoren-pivoxil (3 mg/kg t.i.d. for 5 days) or amoxicillin (10 mg/kg t.i.d. for 10 days) was administered to patients with group A streptococcal pharyngotonsillitis attending the pediatric outpatient clinic of Showa Hospital (Konan, Japan) between January and December 2006. Diagnosis was based on isolation of bacteria from a pharyngeal swab. Culture was always done to confirm eradication, and urinalysis and follow-up were performed at least once weekly for 4 weeks. Among 258 patients, 103 (aged 5.5 +/- 2.3 years) received cefditoren-pivoxil and 155 (aged 5.2 +/- 2.0 years) received amoxicillin. There were no significant between-group differences in age, sex, or symptoms. Eradication was confirmed in 99% (102/103) of the cefditoren-pivoxil group and 100% of the amoxicillin group. Recurrence within 4 weeks occurred in 8 and 15 patients in the cefditoren-pivoxil and amoxicillin groups, respectively, showing no significant difference in the recurrence rate, and all isolates had the same serotypes as before. There were no clinically significant adverse reactions or complications. The 50%/90% minimum inhibitory concentrations (microg/ml) of cefditoren-pivoxil and amoxicillin for the 258 isolates were < or =0.03/< or =0.03 and < or =0.03/0.06, respectively, so all isolates were susceptible to both agents. Because the efficacy for pediatric group A streptococcus pharyngotonsillitis was similar between oral cefditoren-pivoxil for 5 days and amoxicillin for 10 days, the shorter treatment period may make the former regimen preferable.

Topics: Amoxicillin; Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Male; Microbial Sensitivity Tests; Outpatient Clinics, Hospital; Pharyngitis; Prospective Studies; Recurrence; Serotyping; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis; Treatment Outcome