Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin g in low-resource settings: A randomized controlled trial

Anne W. Rimoin, Nicole A. Hoff, Christa L. Fischer Walker, Hala S. Hamza, Adriana Vince, Naglaa Abdel Rahman, Sasa Andrasevic, Soha Emam, Dubravka Vukelic, Nevine Elminawi, Hadeer Abdel Ghafar, Antonia L.A. Da Cunha, Shamim Qazi, Dace Gardovska, Mark C. Steinhoff

Research output: Contribution to journalArticle

Abstract

Background: Primary prevention of acute rheumatic fever is achieved by proper antibiotic treatment of group A β -hemolytic streptococcal (GAS) pharyngitis. Methods: To assess noninferiority of oral amoxicillin to intramuscular benzathine penicillin G (IM BPG). Children (2 to 12 years) meeting enrollment criteria were randomized 1:1 to receive antibiotic treatment in 2 urban outpatient clinics in Egypt and Croatia. Results: A total of 558 children (Croatia = 166, Egypt = 392) were randomized, with 368 evaluable in an intention-to-treat (ITT) analysis, and 272 evaluable in the per protocol (PP) analysis. In Croatia, ITT and PP treatment success rates were comparable for IM BPG and amoxicillin (2.5% difference vs 1.1% difference, respectively). In Egypt, amoxicillin was not comparable with IM BPG in ITT analysis (15.1% difference), but was comparable in PP analysis (-9.3% difference). Conclusion: If compliance is a major issue, a single dose of IM BPG may be preferable for treatment of GAS pharyngitis.

Original languageEnglish (US)
Pages (from-to)535-542
Number of pages8
JournalClinical pediatrics
Volume50
Issue number6
DOIs
StatePublished - Jun 2011

Keywords

  • amoxicillin
  • intramuscular benzathine penicillin G
  • randomized clinical trial
  • streptococcal pharyngitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Rimoin, A. W., Hoff, N. A., Fischer Walker, C. L., Hamza, H. S., Vince, A., Rahman, N. A., Andrasevic, S., Emam, S., Vukelic, D., Elminawi, N., Ghafar, H. A., Da Cunha, A. L. A., Qazi, S., Gardovska, D., & Steinhoff, M. C. (2011). Treatment of streptococcal pharyngitis with once-daily amoxicillin versus intramuscular benzathine penicillin g in low-resource settings: A randomized controlled trial. Clinical pediatrics, 50(6), 535-542. https://doi.org/10.1177/0009922810394838