Effectiveness and Safety of Short-Course vs Long-Course Antibiotic Therapy for Group A β-Hemolytic Streptococcal Tonsillopharyngitis: A Meta-analysis of Randomized Trials

Falagas, Matthew E.; Vouloumanou, Evridiki K.; Matthaiou, Dimimlos K.; Kapaskelis, Anastasios M.; Drosos E.6Karageorgopoulos
August 2008
Mayo Clinic Proceedings;Aug2008, Vol. 83 Issue 8, p880
Academic Journal
OBJECTIVE: To evaluate the effectiveness and safety of short- course antibiotic treatment of group A ß-hemolytic streptococcal (GAS) tonsiliopharyngitls. METHODS: We performed a meta-analysis of randomized controlled trials (RCT5) retrieved from PubMed and the Cochrane Central Register of Controlled Trials using a structured search strategy. The last date either database was accessed was November 14, 2007. We Included RCTs that Involved patients of any age with GAS tonsillopharyngitis, comparing short-course (≤7 days) vs long-course (at least 2 days longer than short-course) treatment with the same antibiotics. The primary analysis compared 5 to 7 days with 10 days of treatment, using a random effects model. RESULTS: Eleven RCT5 comparing short-course vs long-course treatment (5 with penicillin V, 4 with oral cephalosporins, 1 with intramuscular ceftriaxone, and I with clindamycln; 6 of the 11 were open label) were inciuded. In the primary analysis, microbiological eradication rates of GAS were inferior for short-course vs long-course treatment (8 RCTs, 1607 patients; odds ratio [OR], 0.49; 95% confidence interval [Cl], 0.32-0.74). This association was noted with penicillin V treatment (3 RCTs, 500 patients; OR, 0.36; 95% Cl, 013-0.99) but was nonsignificant with cephalosporin treatment (4 RCTs, 1018 patients; OR, 0.62; 95% Cl, 0.38-1.03). Microbiological eradication was less likely with short-course treatment in trials Involving primarily children and adolescents (aged <18 years) (6 RCT5, 1258 patients; OR, 0.63; 95% Cl, 040-0.98). Clinical success was Inferior in patients who received short-course treatment (5 RCT5, 1217 patients; OR, 0.49; 95% CI, Adverse events did not differ between compared groups. The above associations were consistent In the analyses involving all included RCTs. CONCLUSION: Short-course treatment for GAS tonslilopharyngitis, particularly with penicillin V, is associated with Inferior bacteriological eradication rates.


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