Short course of antibiotics as effective as standard duration for streptococcal pharyngitis in children

Clinical question: 
How effective is 2 to 6 days of oral antibiotics (short duration) compared to 10 days of oral penicillin (standard duration) in treating children with acute group A beta haemolytic streptococcus (GABHS) pharyngitis?
Bottom line: 
Threeto 6 days' treatment with oral antibiotics (macrolides, cephalosporinsor amoxicillin) has comparable efficacy to the standard-duration 10days of oral penicillin in treating children with acute GABHSpharyngitis. Compared to standard-duration treatment, theshort-duration treatment had shorter periods of fever, and throatsoreness, lower risk of early clinical treatment failure, nosignificant difference in early bacteriological treatment failure orlate clinical recurrence. The shorter duration of antibiotic treatmentmay be more convenient to the patient, will improve compliance andreduce failure rate, reduce return visits to the physician, andultimately overall cost. No conclusions can be drawn on the comparisonof complication rates of acute rheumatic fever and acutepoststreptococcal glomerulonephritis.
Caveat: 
The short-duration treatment (2-6 days) resulted in better compliance, butmore side effects (mostly self-limiting mild to moderate diarrhoea,vomiting and abdominal pain). In areas where the prevalence ofrheumatic heart disease is still high, these results must beinterpreted with caution.
Context: 
Thestandard-duration treatment for acute GABHS pharyngitis with oralpenicillin is 10 days. Shorter-duration antibiotics may have comparableefficacy.
Review CD#: 
CD004872
PEARLS No: 
160
Date: 
May, 2009
Authored by: 
Brian R McAvoy