WASHINGTON — A short-course regimen with a cephalosporin was more effective than a 10-day regimen with penicillin for curing strep throat, based on a metaanalysis of 14 studies done in adults and children.
A short-course regimen, which usually lasts 5 days, runs counter to what most physicians were taught to use to treat tonsillopharyngitis caused by group A streptococci, Janet R. Casey, M.D., said in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
But physicians must realize that many patients won't take an antibiotic for 10 days, and so they should consider prescribing a 5-day course instead. The results from the metaanalysis “are a start toward changing physician behavior,” said Dr. Casey, a pediatrician at the University of Rochester (N.Y.).
The metaanalysis included 14 studies that compared a short-course of a cephalosporin with a 10-day course of penicillin. These studies involved seven different cephalosporins. The most commonly used drug was cefpodoxime (Vantin), in four studies, followed by cefuroxime (Ceftin), in three studies. Cefixime (Suprax) and cefdinir (Omnicef) were each used in two studies, and cefadroxil (Duricef), cefotiam, and cefprozil (Cefzil) were each used in a single study.
The 14 studies enrolled a total of 1,880 patients in the cephalosporin-treated groups and a total of 2,760 patients in the penicillin-treated groups.
Twelve of the studies involved a 5-day course of cephalosporin. The remaining two studies used a 4-day course; one 4-day regimen used cefuroxime, and the other used cefixime.
Overall, the results of these 14 studies showed that treatment with a short-course of a cephalosporin produced a 63% higher cure rate than a 10-day course with penicillin, a difference that was statistically significant.
The value of a short-course regimen was highlighted in an analysis of four studies that each compared a 5-day course of a cephalosporin with a 10-day course of the same drug. The results showed that compliance with the 5-day regimens was threefold greater than compliance with the 10-day regimens, Dr. Casey said at the conference, which was sponsored by the American Society for Microbiology.
The only short-course regimens currently approved by the Food and Drug Administration for treating strep throat are 5 days of treatment with azithromycin, cefdinir, or cefpodoxime, Dr. Casey told this newspaper.
The remainder of the 27 total studies in the metaanalysis included studies that compared short-course regimens that used penicillin, amoxicillin, or a macrolide against 10 days of treatment with penicillin or another comparator drug with similar or less efficacy.