Clinical Citations: Comparing the efficacy of antibiotics in the treatment of group A strep throat

Although penicillin has been the antibiotic of choice for group A streptococcal (GAS) tonsillopharyngitis, a number of other antibiotics are used as well. This includes azithromycin, which may be preferred by some because of its dosing schedule. The results of a meta-analysis by Casey and Pichichero indicate that a total treatment dose of 60 mg/kg of azithromycin is necessary to eradicate GAS tonsillopharyngitis in children, and this regimen appears to be more effective than regimens of other antibiotics studied.

The meta-analysis included 19 randomized controlled trials involving 4626 patients. The trials compared 1 or 2 azithromycin regimens with 1 or 2 comparator antibiotics administered for 10 days (Table).

Bacterial failure was 5 times more likely to occur in children who received the 10-day courses of comparator antibiotics than in those who received 60 mg/kg of azithromycin. The rate of bacterial failure was 3 times higher in those who received 30 mg/kg of azithromycin than in those who received comparator antibiotics. The 3-day regimens were shown to be inferior to the 5-day regimens.

In adults, the difference between azithromycin and the comparator antibiotics was not statistically significant, but there was a trend favoring azithromycin (P = .14). In contrast to the finding in children, the 3-day regimens were superior to 5-day regimens.

The differences in clinical cure rates resembled those for bacterial cure rates.