Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin G in low-resource settings: a randomized controlled trial.
Author(s): Rimoin AW, Hoff NA, Fischer Walker CL, Hamza HS, Vince A, Abdel Rahman N, Andrasevic S, Emam S, Vukelic D, Elminawi N, Abdel Ghafar H, da Cunha AL, Qazi S, Gardovska D, Steinhoff MC
Affiliation(s): Department of Epidemiology, UCLA School of Public Health, CHS 41-245, Los Angeles, CA 90005, USA. email@example.com
Publication date & source: 2011-06, Clin Pediatr (Phila)., 50(6):535-42. Epub 2011 Feb 11.
Publication type: Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.
BACKGROUND: Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A beta -hemolytic streptococcal (GAS) pharyngitis. METHODS: To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia. RESULTS: A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference). CONCLUSION: If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.