Summary
The aim of the study was to explore whether penicillin was superior to placebo in altering the clinical course of proven streptococcal pharyngitis. A randomised, parallel, double blind placebo controlled trial of 10 days duration was undertaken in 42 general practices in the Gent region (Flemish part of Belgium). Phenoxymethylpenicillin (adults 250 mg t. i. d. and children 125 mg t.i.d.) or placebo were administrated to 173 patients, aged 5 to 50 y, with acute sore throat and a positive culture for Group Aβ-haemolytic streptococci. Penicillin and placebo tablets were identical. Patient compliance was monitored by assay of penicillin in urine (Sarcina lutea method).
The primary outcome variable was sore throat as recorded by the physician on Day 3. The experiences of the patients themselves over the 10 day period were also assessed. Secondary outcome variables were other local and general symptoms and signs of streptococcal throat infection.
In the penicillin group on Day 3,23.2% of the patients still complained of sore throat versus 65.9% in the placebo group: difference 42.7% (C. I. 29.4%, 56.1%). This finding was confirmed by survival analysis of the symptom ‘sore throat’, as recorded by the patients. The physicians recorded on Day 3 a significant positive effect on another symptom (malaise:P < 0.04) and certain clinical signs (abnormal throat:P < 0.07; and redness of throat:P < 0.003). Penicillin had more adverse effects than placebo (P < 0.007). It also inhibited the rise in ASLO (P < 0.001).
In this study in general practice, penicillin had a slight but definitive positive effect on the clinical evolution of streptococcal pharyngitis. The clinical importance of this finding is not certain, as the physician in the community may lack the means to distinguish between viral and bacterial pharyngitis.
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References
Denny FW, Wannamaker LW Brink WR, Rammelkamp CH, Custer EA (1950) Prevention of rheumatic fever. Treatment of the preceding streptococcal infection. JAMA 143: 151–153
Peter G, Smith AC (1977) Group A streptococcal infections of the skin and pharynx. N Engl J Med 297: 365–370
Pichichero ME, Disney FA, Talpey WB, Green JL, Francis AB, Roghmann KJ, Hoekelman RA (1987) Adverse and beneficial effects of immediate treatment of group A beta-hemolytic streptococcal pharyngitis with penicillin. Pediatr Infect Dis 6: 635–643
Randolph M, Gerber M, Demeo K, Wright L (1985) Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr 106: 870–875
Bellon J, Weise B, Verschraegen G, De Meyere M (1991) Selective Streptococcal Agar versus blood agar in the detection of group A beta-hemolytic streptococci in acute pharyngitis. J Clin Microbiol 29: 2084–2085
Charney E, Bynum R, Eldredge D, Frank D, Mc Whinney A, Mc Nabbn S, Scheiner A, Sumpter E, Iker H (1967) How well do patients take oral penicillin? A collaborative study in private practice. Pediatrics 40: 188–195
Bennike T, Brochner-Mortensen K, Kjaer E, Skadhange K, Trolle E (1951) Penicillin therapy in acute tonsillitis, phlegmonous tonsillitis and ulcerative tonsillitis. Acta Med Scand 139: 253–274
Jersild T (1948) Penicillin therapy in scarlet fever and complicating otitis. Lancet 1: 671–673
Brink WR, Rammelkamp CH Jr., Denny FW, Wannamaker LW (1951) Effect of penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis. Am J Med 10: 300–308
Brumfitt W, O'Grady F, Slater J (1959) Benign streptococcal sore throat. Lancet II: 419–421
Denny FW, Wannamaker LW, Hahne EO (1953) Comparative effects of penicillin, aureomycin and terramycin on streptococcal tonsillitis and pharyngitis. Pediatrics 11: 7–13
Gerber MA, Randolph MF, Mayo DR (1988) The group A streptococcal carrier state. A reexamination. Am J Dis Child 142: 562–565
Nelson JD (1984) The effect of penicillin therapy on the symptoms and signs of streptococcal pharyngitis. Pediatr Infect Dis J 3: 10–13
Krober MS, Bass JW, Michels GN (1985) Streptococcal Pharyngitis. Placebo-controlled double-blind evaluation of clinical evaluation of clinical response to penicillin therapy. JAMA 253: 1271–1274
Chapple PA, Franklin LM, Paulett JD, Tuckman E, Woodall J, Tomlinson A, Mc Donald J (1956) Treatment of acute sore throat in general practice. Therapeutic trial with observations on symptoms and bacteriology. Br Med J 1: 705–708
Whitfield MJ, Hughes AO (1981) Penicillin in acute sore throat. Practitioner 225: 234–239
Merenstein JH, Rogers KD (1974) Streptococcal pharyngitis: early treatment and management by nurse practitioners. JAMA 227: 1278–1280
Smith D, Bell SM, Cranney KS (1969) Diagnosis and treatment of acute pharyngitis in general practice. Med J Aust 1: 803–806
Brumfitt W, Slater JD (1957) Treatment of acute sore throat with penicillin. Lancet I: 8–11
De Melker RA (1987) Recurrent upper respiratory tract infections viewed as a natural phenomenon and a problem with multiple causation. Allgemein Medizin 16: 29–36
Hjortdahl P, Laerum E, Mowinckel P (1988) Clinical assessment of pharyngitis in general practice. Scand J Prim Health Care 6: 219–223
Radetsky M, Todd JK (1984) Criteria for the evaluation of new diagnostic tests. Pediatr Infect Dis J 3: 461–466
Radetsky M, Wheeler RC, Roe MH, Todd JK (1985) Comparative evaluation of kits for rapid diagnosis of group A streptococcal disease. Pediatr Infect Dis 4: 274–281
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De Meyere, M., Mervielde, Y., Verschraegen, G. et al. Effect of Penicillin on the clinical course of streptococcal pharyngitis in general practice. Eur J Clin Pharmacol 43, 581–585 (1992). https://doi.org/10.1007/BF02284954
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DOI: https://doi.org/10.1007/BF02284954