Analysis of Clarithromycin and Propicillin in the Management of Streptococcal Pharyngotonsillitis in Children
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Objective: To compare the clinical and bacteriological efficacy and safety of clarithromycin and propicillin in the treatment of streptococcal pharyngotonsillitis in children.
Design: This was a prospective, non-blind, longitudinal, comparative study. All patients included were randomised to receive either clarithromycin or propicillin.
Setting: Participants were outpatients attending a private paediatric clinic in Celaya, Guanajuato, Mexico.
Patients: Patients aged between 1 and 15 years presenting with signs and symptoms of pharyngotonsillitis were enrolled in this study.
Interventions and Outcome Measures: The dosage of clarithromycin was 15 mg/kg/day divided into two daily doses, and for propicillin it was 25 000 U/kg/day divided into three daily doses. Both drugs were given for 10 days. Patients were evaluated according to resolution of signs and symptoms, and adverse events. Pharyngeal cultures were collected at the initial office visits and 3 days after the conclusion of drug therapy. Data were analysed using the Epi5 computer program and χ2 tests were performed regarding time to resolution of clinical signs, adverse events and bacteriological cure.
Results: Of the 387 patients presenting with signs of pharyngotonsillitis, 189 were culture positive. A total of 102 were randomised to receive clarithromycin and 87 to receive propicillin. A statistically significant difference in resolution of clinical signs at 48 hours after initiation of treatment was found in favour of clarithromycin for dysphagia (χ2 = 59.21; p < 0.00001), pharyngeal erythema (χ2 = 61.48; p < 0.00001) and pharyngeal exudate (χ2 = 103.61; p < 0.00001). Statistically significant differences in favour of clarithromycin were also seen on days 5, 7 and 9 of treatment for all these signs. Bacteriological efficacy tended to be higher with clarithromycin [relative rate for bacteriological success with clarithromycin = 1.11; confidence interval = 1.00 to 1.24;χ2 (Yates) = 3.05; p = 0.08]; these differences were not significant. 11 patients would need to be treated with clarithromycin to yield bacteriological success in 1 additional patient. Clarithromycin showed a lower overall rate of adverse events, but abdominal pain and nausea were more common with this agent.
Conclusions: Clarithromycin is an excellent alternative in the treatment of streptococcal pharyngotonsillitis in children because of its higher clinical (95% vs 86% of propicillin) and bacteriological (92% vs 82% of propicillin) efficacy and the faster rate of improvement than with propicillin.
KeywordsAdis International Limited Clarithromycin Rheumatic Fever Tonsillitis Clin Drug Invest
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