Vol.52 No.8 August 2004

Clinical efficacy of oral antibiotics in treating pharyngotonsillitis caused by Streptococcus pyogenes A comparative study of eradication among 6 agents

Eiichi Nakayama^1,3), Katsuhiko Sunaoshi^2,3), Etsuko Suzuki³⁾, Reiko Kobayashi³⁾, Mei Momomura¹⁾, Naomi Funaki¹⁾, Taketoshi Iizuka¹⁾, Yasuo Kondo⁴⁾, Tsuyoshi Tajima¹⁾ and Kimiko Ubukata³⁾

¹⁾Department of Pediatrics, Hakujikai Memorial Hospital, 5-11-1 Shikahama, Adachi-ku, Tokyo, Japan
²⁾Division of Clinical Microbiology, Saitama Institute of Public Health
³⁾Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University
⁴⁾Kondo Children's Clinic

Abstract

To evaluate the clinical efficacy of antibiotics in treating Streptococcus pyogenes (GAS) pharyngotonsillitis, we studied 622 pediatric outpatients at Hakujikai Memorial Hospital between February 2001 and July 2003. Patients had been diagnosed with GAS pharyngotonsillitis based on clinical signs, throat cultures, and a rapid antigen detection test of GAS. The following antibiotics were randomly assigned to patients by the day of the week: amoxicillin, cefaclor, cefditoren pivoxil (PI), cefcapene pivoxil (PI), clarithromycin, and azithromycin. Throat cultures were obtained before treatment and on a follow-up visit 7 to 10 days after completion of antibiotic treatment, and GAS eradication among these agents was compared.
Cefditoren PI showed the highest eradication (149/158 patients; 94.3%), followed by amoxicillin (98/110; 89.1%), cefcapene PI (111/128; 86.7%), clarithromycin (63/75; 84.0%), cefaclor (65/80; 81.3%), and azithromycin (54/71; 76.1%). Cefditoren PI significantly reduced failure compared to antibiotics other than amoxicillin.
Of patients who had positive strains of macrolide resistance gene of mefA or ermB, eradication of GAS was failured in all episodes after treatment with clarithromycin or azithromycin (n=11).
Our data suggests that β -lactam antibiotics are more proper agents than macrolides in treating GAS pharyngotonsillitis.

Key word

Streptococcus pyogenes, pharyngotonsillitis, macrolide-resistant gene, eradication rate, oral antibiotics

Received

May 18, 2004

Accepted

July 13, 2004

Jpn. J. Chemother. 52 (8): 426-432, 2004