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Sore throat is a common chief complaint in general pediatric practice, accounting for 4% to 8% of office visits. Group A [beta]-hemolytic streptococcal (GAS) infections account for 20% to 40% [...]

Objective. To assess the marginal impact of patient education on antibiotic prescribing to children with pharyngitis and adults with acute bronchitis in private office practices. Data Sources/Study Setting. Antibiotic prescription rates based on claims data from four managed care organizations in Colorado during baseline (winter 2000) and study (winter 2001) periods. Study Design. A nonrandomized controlled trial of a household and office-based patient educational intervention was performed. During both periods, Colorado physicians were mailed antibiotic prescribing profiles and practices guidelines as part of an ongoing quality improvement program. Intervention practices (n = 7) were compared with local and distant control practices. Data Collection/Extraction Methods. Office visits were extracted by managed care organizations using International Classification of Diseases-9-Clinical Modification codes for acute respiratory tract infections, and merged with pharmacy claims data based on visit and dispensing dates coinciding within 2 days. Principal Findings. Adjusted antibiotic prescription rates during baseline and study periods increased from 38 to 39 percent for pediatric pharyngitis at the distant control practices, and decreased from 39 to 37 percent at the local control practices, and from 34 to 30 percent at the intervention practices (p = . 18 compared with distant control practices). Adjusted antibiotic prescription rates decreased from 50 to 44 percent for adult bronchitis at the distant control practices, from 55 to 45 percent at the local control practices, and from 60 to 36 percent at the intervention practices (p < .002 and p = .006 compared with distant and local control practices, respectively). Conclusions. In office practices, there appears to be little room for improvement in antibiotic prescription rates for children with pharyngitis. In contrast, patient education helps reduce antibiotic use for adults with acute bronchitis beyond that achieved by physician directed efforts. Key Words. Antibiotics, patient education, physician practice patterns, quality improvement, Multiple organizations have called for decreases in excess antibiotic use in ambulatory practice as an important component of strategies to combat antimicrobial resistance in the United States (Jernigan, Cetron, and [...]

A higher dose of amoxicillin appears to be more effective than the standard dose of penicillin in children with group A streptococcal throat infections. Researchers randomly assigned 113 children to receive 40 milligrams per kilogram per day (mg/kg/day) of amoxicillin or the standard penicillin dose, which is approximately 18 mg/kg/day. After 10 days of treatment, 80% of the children on amoxicillin had been cured, compared to 55% of those on penicillin. Only 10% were still colonized by the bacterium, compared to 24% of those on penicillin.

PRACTICE CHANGER Consider prescribing a single dose of corticosteroids for patients with sore throat, which has been found to bring quicker pain relief and resolution of symptoms. STRENGTH OF RECOMMENDATION [...]

Introduction Patients with sore throat are commonly seen in primary care.[1] Though recent guidelines advocate using results from throat swabs--or clusters of symptoms or signs--to determine which patients should be [...]

Objective: To compare the safety and efficacy of a 5-day regimen of cefdinir with those of a conventional 10-day regimen of penicillin V for the treatment of streptococcal pharyngitis in children. Design: Investigator-blind, randomized controlled trial. Setting: Primary care, ambulatory. Patients: Children aged 1 to 12 years with signs and symptoms of pharyngitis and a positive result on a rapid screening test for Streptococcus pyogenes (ie, a convenience sample). Four hundred eighty-two patients were enrolled in the study, and 440 were clinically and microbiologically evaluable. The most common reasons patients were nonevaluable were failure to return for specified visits and noncompliance with the administration of the medication; 2 patients receiving penicillin V discontinued use of the drug because of adverse events. Intervention: Patients were randomized to receive either 7-mg/kg cefdinir, twice daily, for 5 days or 10-mg/kg penicillin V potassium, 4 times daily, for 10 days. Main Outcome Measures: The eradication of S pyogenes and the clinical cure of the signs and symptoms of pharyngitis, both determined 5 to 10 days after the completion of therapy. Results: Streptococcus pyogenes was eradicated in 201 (90%) of the 224 patients receiving cefdinir and 155 (72%) of the 216 patients receiving penicillin V (95% confidence interval [CI], 10.7%-25.1%; P [is less than] .001). The clinical cure rates were 92% and 91% in the groups receiving cefdinir and penicillin V, respectively (95% CI, -4.5% to 6.1%; P=.80). Adverse events, regardless of the opinion of the investigator about their relationship to the study medication, occurred in 12.5% of the patients receiving cefdinir and 13.6% of the patients receiving penicillin V (P=.69). Conclusions: A 5-day regimen of cefdinir eradicated a higher proportion of S pyogenes than a 10-day regimen of penicillin V. No difference was noted between the regimens for clinical outcomes or adverse event rates., Five days of oral cefdinir treatment may be superior to 10 days of oral penicillin V in treating strep throat in children. Researchers randomly assigned 440 children aged 1 to 12 with positive throat tests for Streptococcus pyogenes to either cefnidir twice a day for 5 days or penicillin V four times a day for 10 days. Clinical cure rates were similar: 92% and 91%, respectively. However, Streptococcus pyogenes was eradicated in 90% of the cefdinir group but only 72% of the penicillin group. Minor side effects were equally common in both groups.

Objective: To compare bacteriologic and clinical efficacy and safety of 10 vs 5 days of cefpodoxime proxetil vs 10 days of penicillin V potassium for the treatment of acute group A B-hemolytic streptococcal tonsillopharyngitis in children. Design: Prospective, randomized, observer-blind, multicenter study. Patients/Interventions: Four hundred eighty-four children (age range, 2 to 17 years) with signs and symptoms of acute tonsillopharyngitis were enrolled; 377 had a positive throat culture for group A B-hemolytic streptococci and were fully evaluable. One hundred twenty-one patients received cefpodoxime once a day for 10 days, 126 received cefpodoxime twice a day for 5 days, and 130 received penicillin V three times a day for 10 days. Results: Cefpodoxime for 10 days vs cefpodoxime for 5 days vs penicillin V for 10 days produced bacteriologic eradication at the end of therapy in 95%, 90%, and 78% of the patients, respectively. The 10- and 5-day cefpodoxime treatment regimens were more efficacious than penicillin V (P=.003 and P=.02, respectively). The cumulative bacteriologic failure rate among assessable patients by the 32- to 38-day posttreatment visit was 20 (17%) of 121 patients who were treated with cefpodoxime for 10 days, 24 (19%) of 125 patients who were treated with cefpodoxime for 5 days, and 45 (35%) of 130 patients who were treated with penicillin V for 10 days (P=.001 and P=.005, respectively). Clinical cure or improvement was observed at the end of therapy in 96%, 94%, and 91% of the patients, respectively (P=not significant). Adverse events were infrequent and similar in all three treatment groups, with minor gastrointestinal side effects predominating. Conclusions: Five days of treatment with cefpodoxime is as efficacious in bacteriologic eradication and clinical response (cure plus improvement) as 10 days of cefpodoxime therapy, and both cefpodoxime regimens produced superior bacteriologic efficacy compared with a 10-day regimen of penicillin V in the treatment of group A B-hemolytic streptococcal tonsillopharyngitis in children. (Arch Pediatr Adoles Med. 1994;148:1053-1060), Cefpodoxime seems to be at least as effective as penicillin for the treatment of tonsillopharyngitis in children. Tonsillopharyngitis is a throat infection. Researchers studied 377 children between the ages of two and 17 who had tonsillopharyngitis caused by the group A beta-hemolytic streptococcus bacterium. Of these, 121 children received 10 milligrams per kilogram of body weight(mg/kg) of cefpodoxime once a day for 10 days; 126 received 10 mg/kg of cefpodoxime divided into two doses per day for five days, and 130 received 40 mg/kg penicillin V divided into three doses per day for 10 days. The disease was cured in 89% of the patients who took cefpodoxime for ten days, 75% of those taking cefpodoxime for five days, and 76% of patients treated with penicillin. Both regimens of cefpodoxime eradicated streptococcal bacteria more efficiently than penicillin. There were no significant differences in the rate of adverse affects or infection recurrence among patients in all treatment groups.

Background. Streptococcal pharyngitis, caused by group A [beta]-hemolytic streptococci (GABHS), is among the most common infections seen by primary care physicians. Because the illness can result in rheumatic fever, early eradication of infection is important. Penicillin has been the standard treatment for GABHS pharyngitis for over four decades, but reports of bacteriologic failure with this drug in recent years have led to trials of alternative antimicrobials. Methods. In this investigator-blind, randomized multicenter trial (30 centers), oral clarithromycin, 250 mg twice daily, or oral penicillin VK, 250 mg three times daily, was given to outpatients [is greater than or equal to] 12 years old with GABHS pharyngitis as documented by positive cultures for Streptococcus pyogenes and positive rapid immunoassay tests. The clinical and bacteriologic efficacy of clarithromycin was compared with that of penicillin in the 356 evaluable patients. Safety analysis was performed in all patients who had received at least one dose of the study drug (N = 453). Results. Overall, clinical outcomes were comparable in the two groups. However, more clarithromycin-treated patients than penicillin-treated patients had resolution of sore throat (94% vs 86%, P = .014) and disappearance of pharyngeal erythema and exudate (89% vs 82%, P = .05). Bacteriologic cure rates were higher in clarithromycin-treated patients (95% vs 87%, P = .009). No serious adverse events were observed in either group. Conclusions. This study suggests that clarithromycin twice daily is as effective and as well tolerated as penicillin in the treatment of streptococcal pharyngitis., Streptococcal pharyngitis is caused by Streptococcus pyogenes, a group A [beta]-hemolytic streptococcus (GABHS), and is among the most common conditions treated by primary care physicians in the United States.[1] An [...]

The growing rate of penicillin failure in the treatment of streptococcal pharyngitis compounded by a resurgence of serious complications associated with these infections indicates the need for more aggressive alternative therapies. For more than 40 years, the standard treatment for streptococcal pharyngitis - more commonly referred to as strep throat - has been 10 days of penicillin. Penicillin failure rates have risen from under 10% in previous decades to over 20% in the 1980s. Some explanations for penicillin failure include lack of patient compliance, repeated exposure to infectious agents, the existence of co-pathogens that protect bacteria from penicillin, antibiotic suppression of immunity and penicillin tolerance. While penicillin is still the drug of choice for streptococcal pharyngitis, effective alternative treatments are erythromycin, cephalosporins and amoxicillin/clavulanic acid.

Loracarbef, a member of the carbacephem class of [Beta]-lactam antibiotics, is a potent anti-bacterial agent. In a double-blind, randomized clinical trial to assess efficacy and safety of loracarbef in the treatment of streptococcal pharyngitis and tonsillitis, 107 adult patients were treated with loracarbef (200 mg capsules twice a day or 15 mg/kg/day suspension) and 111 patients were treated with penicillin VK (250 mg capsules four times a day or 20 mg/kg/day suspension) for 10 days. In the loracarbef treatment group, 96.6% of the evaluable patients had a favorable clinical response 3-5 days after therapy, a result that compared favorably with the 93.9% response rate achieved in the penicillin group. The clinical failure/relapse rates were 3.4% for loracarbef-treated patients and 6.1% for patients receiving penicillin. Bacteriologic response data approximated the clinical result, with a successful response in 89.9% of the loracarbef-treated patients and 91.5% of the penicillin recipients. Two (1.9%) loracarbef-treated patients with rash and one (0.9%) penicillin-treated patient with diarrhea discontinued the study early because of these adverse events. The incidence of adverse events was comparable in the two treatment groups except for increased cough, which was reported by 3.7% of the loracarbef-treated patients and none of the penicillin recipients. These data support the conclusion that loracarbef is comparable to penicillin VK in the treatment of streptococcal pharyngitis and tonsillitis in adults.

Over-the-counter drugs containing aspirin and caffeine are widely available and used, but few studies have examined whether this combination is effective in relieving pain. A total of 210 patients who came to their family physician's office with sore throats were randomly assigned to receive either aspirin with caffeine, aspirin alone, or placebo (inert pills). They remained in the office for two hours, and were asked to rate their pain and the degree and rapidity of relief they had experienced at the end of that time. Both aspirin alone and aspirin with caffeine were significantly better than placebo at relieving pain, decreasing swelling, and easing difficulty with swallowing, and aspirin with caffeine was better than plain aspirin at easing those symptoms. In addition, the aspirin with caffeine combination began acting 15 minutes after it was taken, and it retained its greater efficacy over plain aspirin at 30, 90, and 120 minutes. The mechanism whereby the caffeine improves the effect of the aspirin is not known, but it is theorized that the caffeine increases the release of stomach acid, which enables the aspirin to be absorbed more rapidly. Thus, aspirin with caffeine appears to be more effective at relieving sore throat pain than aspirin alone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection with group A beta-hemolytic streptococcal pharyngitis (GABHS) - pharyngitis is a sore throat - is effectively treated with antibiotics, but one belief that has persisted is that treatment immediately after diagnosis is less effective than treatment started 48 hours later. This is thought to be a consequence of the prevention of one kind of immune response (type-specific immunity) if antibiotics are given too soon. However, not all researchers agree on this point. To compare the effects of penicillin V treatment started immediately after diagnosis with the effects of treatment started 48 hours later, 113 patients (age 2 to 22 years) were randomly assigned to one of the two groups. All had positive results from a throat culture test and a rapid antigen detection test. To evaluate the effectiveness of treatment, patients were followed-up a few days later, as well as two and four months later. Results showed that 39 percent of the whole group had GABHS in throat culture specimens at a follow-up visit. However, no differences were seen at any follow-up point between the two treatment groups with respect to positive throat cultures, recurrences of infection, recurrences of symptoms, or new infections. A review of the medical literature on this topic, which also discusses the role of type-specific antibodies in light of recent immunological research findings, is presented. In summary, immediate treatment of GABHS pharyngitis with penicillin appears as effective as delayed treatment. Since immediate treatment provides faster relief of symptoms and reduces the risk of disease transmission, delaying treatment cannot be recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

One reason for the failure of penicillin to eradicate acute streptococcal pharyngitis (sore throat due to infection with group A beta-hemolytic streptococci, or GABHS) could be the presence in the throat of other microorganisms that render penicillin ineffective. This could occur as a result of the production by bacteria of beta-lactamase, an enzyme that interferes with penicillin's antimicrobial effect. To evaluate this possibility, patients with acute pharyngitis were treated either with an antibiotic used against both GABHS and beta-lactamase-producing bacteria (amoxicillin-clavulanic acid), or an antibiotic against GABHS only (phenoxymethyl penicillin, also called penicillin V). Forty-three penicillin patients and 46 amoxicillin-clavulanic acid patients completed the study: patients were 7 years old, on average. Effective treatment was defined as elimination of the original streptococcal organism at a follow-up visit within several days of their last use of medication. Results showed that throat culture results remained positive for the same GABHS strain in 6.5 percent of the patients treated with amoxicillin-clavulanic acid and in 2.3 percent of those treated with penicillin; these rates were not significantly different. Moreover, two of the three treatment failures in the amoxicillin-clavulanic acid group were in children who had not produced beta-lactamase at the start of the study, so failure could not be said to be a result of the enzyme. The findings of this admittedly small study indicate that treatment failure against GABHS pharyngitis cannot be corrected by adding an agent against beta-lactamase-producing bacteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

With the winter season just around the corner you anticipate numerous patient enquiries and visits related to the use of antibiotics for the common cold and associated morbidities. One day [...]

Most patients with a throat infection should not be treated with antibiotics unless they are infected with group A beta-hemolytic streptococcus. If so, they should be treated with penicillin or erythromycin. All other patients should be treated with pain-killers, anti-fever medications, and other supportive care.

Abstract Objective: To assess the medicalising effect of prescribing antibiotics for sore throat. Setting: 11 general practices in England. Design: Randomised trial of three approaches to sore throat: a 10 [...]

Abstract Objective--To evaluate treatment of group A β haemolytic streptococcal pharyngitis with amoxycillin once daily compared with phenoxymethylpenicillin three or four times a day. Design--Randomised controlled study of consecutive patients [...]

A case-study of a 68-year-old man with the chief complaint of sore throat is presented. The symptoms and the treatments given to the man are also discussed.

Advising on OTC treatment Alan Nathan Two common upper respiratory tract conditions - the common cold and influenza - show similar symptoms and are often confused by patients. Treatment The [...]

In almost two-thirds of primary care office visits for pharyngitis, health care practitioners sidestep established guidelines, usually by testing or prescribing antibiotics to patients at low risk of streptococcal pharyngitis. [...]

Sore Points on Treating Sore Throats Abstract & Commentary By Eileen C. West, MD, Director of Primary Care Women's Health, Clinical Assistant Professor of Internal Medicine, University of Oklahoma School [...]

Antibiotics are frequently prescribed inappropriately to children with sore throats, according to findings of a study that was published in the November 8, 2005, issue of the Journal of the [...]

Confirming an infection by culture can reduce unnecessary antibiotic use among children with pharyngitis caused by group A [beta]-hemolytic streptococci (GABHS), said Maria Carmen G. Diaz, M.D., and her associates [...]

Prestige Brands is backing its Ultra Chloraseptic spray for sore throat pain with a #360,000 advertising campaign. Advertising will appear in women's and men's magazines from mid October until February. [...]