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Cephalexin and Penicillin in the Treatment of Group A β-Hemolytic Streptococcal Throat Infections

Frank A. Disney, MD; Hugh Dillon, MD; Jeffrey L. Blumer, MD, PhD; Burton A. Dudding, MD; Samuel E. McLinn, MD; David B. Nelson, MD; Steven M. Selbst, MD
Am J Dis Child. 1992;146(11):1324-1327. doi:10.1001/archpedi.1992.02160230082024.
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• Objective.  —To determine whether cephalexin or penicillin is more effective in the treatment of group A β-hemolytic streptococcal tonsillopharyngitis in children.

Design.  —Randomized, double-blind, crossover study conducted from 1981 to 1984.

Setting.  —Seven pediatric practices in the United States, including private offices and pediatric clinics. Participants.—Of the 654 patients, 525 children and adolescents with clinical evidence of tonsillitis or pharyngitis and throat cultures positive for group A β-hemolytic streptococcal infection were evaluable. Eighty percent of patients completed the study; none were withdrawn because of adverse reaction.

Selection Criteria.  —Children and adolescents who had acute illness suggestive of group A β-hemolytic streptococcal infection were enrolled in the study. Treatment was continued if the throat culture was positive for group A β-hemolytic streptococcal infection.

Interventions.  —Four doses of cephalexin and penicillin (27 mg/kg per day) were prescribed to be taken on an empty stomach for 10 days.

Measurements/Main Results.  —Symptomatic clinical failure occurred in 8% of penicillin-treated patients and in 3% of cephalexin-treated patients. Bacteriologic failure rates were 11% in the penicillin treatment group and 7% in the cephalexin treatment group. The combined treatment failure rate of clinical relapse plus asymptomatic bacteriologic failure was 19% in the penicillin treatment group and 10% in the cephalexin treatment group. Paired antistreptolysin-O titer increased significantly in 62.3% of penicillin-treated patients and in 64.2% of cephalexin-treated patients. Similarly, anti-DNase B titers rose 52.2% in penicillin-treated patients and 52.4% in cephalexin-treated patients.

Conclusion.  —Cephalexin is a more effective drug than penicillin in the treatment of group A β-hemolytic streptococcal throat infection in children.(AJDC. 1992;146:1324-1327)

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