Comparative efficacy and safety of 5-day cefprozil and 10-day amoxicillin treatment of group A streptococcal pharyngitis in children

BACKGROUND: In recent years attempts have been made to shorten antibiotic treatment for streptococcal pharyngitis. The aim of this study was to evaluate the efficacy and safety of a short course treatment with cefprozil in acute group A beta-hemolytic streptococcal (GABHS) pharyngitis in children, comparing 5-day treatment with a cefprozil suspension and 10-day treatment with an amoxicillin suspension.METHODS: This multicentre, randomized, single-blind study recruited children aged 2 to 12 years old presenting with an acute GABHS pharyngitis. Children were randomly allocated in a 1:1 ratio to receive cefprozil suspension 30 mg/kg/day in two divided doses for 5 days, or amoxicillin suspension 50 mg/kg/day in two divided doses for 10 days. Clinical and bacteriological responses were evaluated at the end of therapy (short-term follow-up) and after 28 - 35 days (long-term follow-up).RESULTS: The study enrolled 44 children with acute GABHS pharyngitis (23 males, median age 84 months): 22 children were assigned to the 5-day course of cefprozil and 22 were assigned to the 10-day course of amoxicillin. At the short-term follow-up all the children treated with cefprozil were cured whereas in the amoxicillin group two children (9.1%) improved (P=0.48). At the long-term follow-up in the cefprozil group one child (4.5%) had a clinical relapse compared with no child in the amoxicillin group (difference not significant). The bacteriological success rate was 100% in both groups at the short-term follow-up. At the long-term follow-up one child (4.5%) in the cefprozil group had a positive GABHS strept test with symptoms compared to none in the amoxicillin group (difference not significant). Both regimens were well-tolerated and no severe adverse events were reported. The most frequent treatment related side effects in both groups were generally gastrointestinal complaints and cutaneous reactions.CONCLUSIONS: Our study shows that the efficacy of 5-day cefprozil treatment of GABHS pharyngitis is equivalent to that of conventional 10-day amoxicillin treatment in terms of the resolution of clinical symptoms, bacteriological eradication and recurrence rates. The safety of the two regimens is also similar. A short course of cefprozil suspension may thus be considered an effective alternative treatment for GABHS pharyngitis with a potential for better compliance.