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Once-daily Therapy for Streptococcal Pharyngitis with Amoxicillin vs, Intramuscular Benzathin Penicillin G

Author(s): Saeideh Tarvijeslami |  Hossein Nasirian

Journal: Iranian Journal of Pediatrics
ISSN 2008-2142

Volume: 17;
Issue: Suppl 2;
Start page: 161;
Date: 2007;
Original page

Keywords: Pharyngitis | Group A beta hemolytic streptococcus | Amoxicillin

Objective: Recent studies have shown that amoxicillin, taken once a day may be as effective as oral penicillin V, three or four times a day, as an effective choice for treatment of group A ╬▓-hemolytic streptococcal (GABHS) pharyngitis. The purpose of this study was to evaluate the effectiveness of once-daily amoxicillin vs intramuscular benzathine penicillin G in the treatment of streptococcal pharyngitis.Material & Methods: Children 6-15 years of age presenting to a private pediatric clinic with GABHS pharyngitis in the urban population of Mashhad, Iran. Prospective randomized controlled study in which patients were randomly assigned to receive orally amoxicillin (750 mg once daily) for 10 days versus a single shot of intramuscular benzathin penicillin G (600.000-1.200.000IU). They received orally amoxicillin by a health worker and compliance was monitored. After 48 hours if the first throat culture was positive, the patients were reevaluated by the same physician, and a second throat culture was obtained to evaluate bacteriologic response to treatment. Ninety-nine patients had throat swabs that yielded positive results on culture. In the latter group, 31 children were randomly assigned to receive intramuscularly penicillin, and 68 children were randomly assigned to receive once-daily amoxicillin. Outcomes were measured by impact on the clinical course and response, eradication of GABHS within 48 hours and compliance. Eleven of the amoxicillin-treated patients refused to take the drug, were noncompliant, or did not return for the follow-up visit. Three of this group, had residual positive culture 48 hours after treatment, and had bacteriologic failure with intramuscular penicillin. These were excluded as carriers, leaving 54 amoxicillin-treated patients. The children in the two treatment groups were comparable with respect to age and, gender.Findings: There were no significant differences in the clinical and bacteriological response, bacteriologic failure and residual positive cultures between the two groups after 48 hours. In the amoxicillin group, 18.9% failed to respond to treatment compared to 6.4% in the penicillin group. The difference was not statistically significant (P-value = 0.1).Conclusion: Our study was in line with two studies comparing oral forms of drugs. These data demonstrate that once-daily therapy with amoxicillin is as effective as intramuscular benzatine penicillin G for the treatment of GABHS pharyngitis.

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