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Primary care
Short course penicillin for treating patients with pharyngotonsillitis
  1. Annette Pluddemann,
  2. Carl Heneghan
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Annette Pluddemann, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; annette.pluddemann{at}

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Sore throat is a common reason for antibiotic prescribing. This trial assesses whether a four times per day for five days versus three times per day for 10 days course of antibiotics can be prescribed while maintaining clinical efficacy.

EBM Verdict:

EBM Verdict on: Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study. BMJ 2019;367:l5337. doi: 10.1136/bmj.l5337.

  • A 5-day course of penicillin appears to be as effective as a 10-day course for pharyngotonsillitis with fewer side effects for patients.

Penicillin is the preferred first-choice antibiotic treatment for adults and children with tonsillopharyngitis.1 Usual treatment advice involves a 10-day course of phenoxymethylpenicillin (penicillin V).

Advice to take and complete longer courses of antibiotics is largely based on avoiding serious complications; however, in developed countries, complications of tonsillitis such as acute rheumatic fever and glomerulonephritis are very rare.2 A previous Cochrane review of 20 studies including 13 102 children with acute streptococcal pharyngitis showed that 3–6 days of late-generation antibiotics, including oral penicillin V, …

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  • Contributors AP wrote the first draft and CH contributed to this draft and provided intellectual input. Both authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AP reports grants from NIHR, grants from NIHR School of Primary Care Research (NIHR SPCR ESWG project 390) and occasionally receives expenses for teaching Evidence-Based Medicine. AP is also an Associate Editor of the BMJEvidence-Based Medicine.CH is supported by the NIHR School for Primary Care Research, Evidence Synthesis Working group (NIHR SPCR ESWG project 390). CH is also supported by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, an NIHR Senior Investigator and Editor in Chief of BMJEvidence-Based Medicine.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.