Sore throat is a common reason for prescribing antibiotics in primary care. The overall aim of the study was to determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci (GAS).
Design
In this open label, randomised controlled non-inferiority study, patients aged 6 years and over with pharyngotonsillitis caused by GAS and three or four Centor criteria (fever ≥38.5°C, tender lymph nodes, coatings of the tonsils, and absence of cough), were included between September 2015 and February 2018. Penicillin V 800 mg four times daily for five days (total16 g) was compared with the current recommended dose of 1000 mg three times daily for 10 days (total 30 g).
Results
Patients (n=433) were randomly allocated to the five day (n=215) or 10 day (n=218) regimen. Clinical cure in the per protocol population was 89.6% (n=181/202) in the five day group and 93.3%
(n=182/195) in the 10 day group (95% CI −9.7 to 2.2). Bacteriological eradication was 80.4% (n=156/194) in the five day group and 90.7% (n=165/182) in the 10 day group. Eight and seven patients had relapses, no patients and four patients had complications, and six and 13 patients had new tonsillitis in the five day and 10 day groups, respectively. Time to relief of symptoms was shorter in the five day group. Conclusions
Penicillin V four times daily for five days was noninferior in clinical outcome to penicillin V three times daily for 10 days in patients with pharyngotonsillitis caused by GAS. The number of relapses and complications did not differ between the two intervention groups. Five day treatment with penicillin V four times daily might be an alternative to the currently recommended 10 day regimen.