Short- vs. Long-Course Antibiotic Treatment for Acute Streptococcal Pharyngitis
TAKE HOME MESSAGE
Acute pharyngitis is one of the most common complaints that a physician encounters in the ambulatory care setting, accounting for 1% to 2% of all ambulatory care visits annually and a high antibiotic prescribing rate. However, the majority of these cases is viral and is self-limiting even in cases caused by bacteria belonging to Group A Streptococcus (GAS), namely “Streptococcus pyogenes”
The spread and development of antimicrobial resistance has called attention to the urgent need to optimize the use of antibiotics.
This study aims to assess the clinical and bacteriological effectiveness and safety of short-term antibiotic therapy in comparison with long-term antibiotic regimens for the management of GAS pharyngitis in patients seeking care in primary care.
The majority of the studies included in the systematic reviews compare a short course of broad-spectrum antibiotics such as Macrolides and Cephalosporins with a long course of Penicillin V (i.e., a narrow spectrum antibiotic).
A total of 50 randomized clinical trials were included in this article, constituting the most comprehensive and extensive systematic review of only randomized clinical trials published to date in patients with streptococcal pharyngitis.
Subgroup analysis demonstrated important differences regarding the effectiveness for early clinical cure and early microbiological cure depending on the antibiotic groups included in the comparison:
(a) short-course penicillin was less effective when compared to long-course penicillin V;
(b) short-course macrolides were equally effective when compared to long-course penicillin V;
(c) short-course cephalosporins were more effective when compared to long-course penicillin V.
Doctors Liked to Read More
Background: To evaluate the effectiveness of short courses of antibiotic therapy for patients with acute streptococcal pharyngitis.
Methods: Randomized controlled trials comparing short-course antibiotic therapy (≤5 days) with long-course antibiotic therapy (≥7 days) for patients with streptococcal pharyngitis were included. Two primary outcomes: early clinical cure and early bacterial eradication.
Results: Fifty randomized clinical trials were included. Overall, short-course antibiotic treatment was as effective as long-course antibiotic treatment for early clinical cure. Subgroup analysis showed that short-course penicillin was less effective for early clinical cure (and bacteriological in comparison to long-course penicillin. Short-course macrolides were equally effective, compared to long-course penicillin. Finally, short-course cephalosporin was more effective for early clinical cure and early microbiological cure in comparison to long-course penicillin. In total, 1211 (17.7%) participants assigned to short-course antibiotic therapy, and 893 (12.3%) cases assigned to long-course, developed adverse events.
Conclusions: Macrolides and cephalosporins belong to the list of "Highest Priority Critically Important Antimicrobials"; hence, long-course penicillin V should remain as the first line antibiotic for the management of patients with streptococcal pharyngitis as far as the benefits of using these two types of antibiotics does not outweigh the harms of their unnecessary use.
Comments
You must login to write comment