#128 Evidence that’s tough to swallow: Short course antibiotics for pediatric strep throat
Reading Tools for Practice Article can earn you MainPro+ CreditsJoin Now
Already a CFPCLearn Member? Log in
- Minimal and inconsistent differences in clinical outcomes.
- No significant difference in composite of complications (e.g. rheumatic fever (RF), glomerulonephritis).
- More adverse events: Primarily gastrointestinal (likely related to antibiotic choice).
- Low quality studies: Only three double-blinded.
- Only three studies reported long-term complications (like RF).
- Funding sources not reported.
- No difference in overall clinical response at 1-2 weeks.
- Short course had fewer recurrences at one year (21.9% vs. 24.8%, number needed to treat=35).
- Three cases of RF in short course arm, none with penicillin.
- Limitations: Open-labeled study, outcomes for individual antibiotics not reported.
- About 1/3 of pediatric sore throats due to GAS3; antibiotics are prescribed in 60% of cases.4
- Symptoms normally resolve in 2-5 days.5 Antibiotics improve symptoms by ~16 hours.6 Antibiotics (in GAS patients) help one more patient in four be symptom-free at day three.6
- RF incidence: ~1/100,000 in developed countries, higher in lower socio-economic areas and developing countries.7
- Only penicillin has high level evidence for RF treatment or prevention and is effective if given up to nine days after symptom onset.6,8,9
- Current recommendations: Treat laboratory proven GAS pharyngitis with 10-day penicillin8,10-12 or amoxicillin.8,10,11
- Cephalexin x 10 days if penicillin intolerance.
- Azithromycin (3-5 days), clindamycin or clarithromycin (10 days) if severely penicillin allergic.8,10-12