Penicillin has protracted been the ...

Penicillin has protracted been the favored antibiotic for the treatment of pharyngitis caused by means of group A streptococci, but a certain quantity of recent studies have raised affects about possibly increasing failure rates with penicillin therapy. brace previously published meta-analyses comparing cephalosporins with penicillin hint that cephalosporins are more likely to achieve eradication of streptococcal pharyngitis infection. Casey and Pichichero near another meta-analysis of cephalosporins and penicillin; this analysis included adult patients with strep throat.

The authors intrust with an agencyed rigorous statistical standards to decide which studies merited inclusion in the meta-analysis to avoid one of the criticisms leveled at prior meta-analyses. Of the 66 published reports initially reviewed, solitary eight (including nine trials) were included in the final data analysis. All of the included studies had been performed within the past 25 years, and a variety of first-, second- and third-generation cephalosporins were used among the different trials. A total of 2113 adult patients from the nine trials were lakeed for data analysis.

The primary issue measured was the rate of bacteriologic method of treatment i.e., a negative streptococcal agriculture after antibiotic therapy. To compendium up all the trial be deriveds bacteriologic cure was about twice as likely (odd ratio, 183) with a cephalosporin than with penicillin. Point estimates in seven of the studies favored cephalosporins; four of these showed a statistically significant benefit. brace studies had a nonsignificant incline favoring penicillin.

Clinical remedial treatment i.e., resolution of pharyngitis symptoms, also was about twice as likely with cephalosporins (odd ratio, 229) than with penicillin. When the authors restricted the meta-analysis to trials that passed higher quality standards (for example, double blinding and elimination of chronic streptococci carriers or test-of-cure throat cultures) the redundants ratios were somewhat lower further still favored cephalosporins.

The authors determine that bacteriologic and clinical remedy of streptococcal pharyngitis is about twice as likely to arise with cephalosporin therapy than with penicillin.

Casey JR Pichichero ME Meta-analysis of cephalosporins versus penicillin for treatment of dispose A streptococcal tonsillopharyngitis in adults. Clin Infect Dis June 1 2004;38:1526-34

EDITOR 'S NOTE: Although the authors have gone to considerable continuances to provide a "clean " and reliable meta-analysis, their published flows are missing vital data. Reporting alone odds ratios provides a relative comparison of cephalosporins and penicillin, on the contrary the absolute numbers relating to corrective rates and other outcome measures also are extremityed so that the clinical significance of any differences can be assessed. For example, if the failure rate with a cephalosporin was 2 percent while the failure rate of penicillin was 4 percent it could be said that treatment failure was twice as used by all with penicillin, and perhaps it could then be inferred that penicillin should not be used. If the absolute numbers are reviewed, however, the clinical significance of a 96 percent or a 98 percent succes rate would be often more debatable.

In the meta-analysis reviewed here, a individual trials favored cephalospori n while others favored penicillin, leading common to suspect that, overall, these antibiotics had largely similar validitys An accompanying editorial (1) questions the importance of the 54 percent absolute difference in eradication rates from the loched studies, concluding, for this and other reasons, that "penicillin at this time remains the mix with drugs of choice."--B.Z.

REFERENCE

(1) Bisno AL. Are cephalosporins superior to penicillin for treatment of acute streptococcal pharyngitis? [Editorial] Clin Infect Dis 2004;38:1535-7

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