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Seven Days of Penicillin Are Better Than 3 for Acute Sore Throat

For sore throats due to streptococcal pharyngitis, the recommended treatment is 10 days of penicillin, but some studies support 7 days of therapy. Because symptoms often disappear quickly, these Dutch investigators examined whether 3 days of treatment also might be effective.

A total of 561 patients (age, 15 to 61 years) with acute sore throats and at least 3 criteria for streptococcal infection were randomized to receive placebo, 3 days of penicillin, or 7 days of penicillin. Throat cultures were obtained for all patients, but treatment group was assigned before results were available. At baseline, 50 percent of patients had positive cultures for group A streptococci; 29 percent were positive for other streptococci serogroups.

Symptoms resolved in the 7-day group an average of 1.9 days faster than in the 3-day group and 1.7 days faster than in the placebo group. For patients with group A streptococci, symptoms resolved 2.5 days faster in the 7-day group than in the placebo group; for non-A streptococci, symptoms resolved 1.3 days faster in the 7-day group. Three placebo-treated patients developed peritonsillar abscesses. Streptococci were eradicated in 72 percent, 41 percent, and 7 percent of the 7-day, 3-day, and placebo groups, respectively.

Comment: These results showed that, for relief of sore throat symptoms, a 3-day course of penicillin was no better than placebo, and 7 days might be as good as 10 days. Keep in mind, however, the authors' position that "prevention of acute rheumatic fever is no longer the main reason to treat patients with penicillin in Western Europe, because of the low incidence of this complication." Some clinicians may not agree with this position, as the impact of shorter treatments on rare nonsuppurative complications remains unclear.

— KI Marton

Published in Journal Watch General Medicine February 25, 2000

Citation(s):

Zwart S et al. Penicillin for acute sore throat: Randomised double blind trial of seven days versus three days treatment or placebo in adults. BMJ 2000 Jan 15 320 150-154.

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