Tonsillopharyngitis is usually viral in children younger than three years of age, but between the ages of five and 10, group A beta-hemolytic streptococci (GABHS) account for more than 25 percent of cases. Failure to eradicate the infection with penicillin is becoming more frequent, probably because of the presence of beta-lactamase–producing pathogens such as Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus, tolerance of GABHS to penicillin and poor compliance. GABHS is susceptible to cefuroxime, a broad-spectrum cephalosporin, as are the beta-lactamase–producing pathogens such as H. influenzae, S. aureus and M. catarrhalis. Mehra and associates compared the efficacy of a five-day course of cefuroxime axetil suspension with that of the standard 10-day regimen in children with GABHS tonsillopharyngitis.
The open, randomized, multicenter study included children from three to 13 years of age. After GABHS infection was verified by throat cultures, the children were randomly assigned to receive cefuroxime axetil suspension in a dosage of 10 mg per kg twice daily, for either five days or 10 days (taken after food when possible).
Eradication of infection was similar in the two treatment groups. In the five-day group, the eradication rate was 88 percent (177 of 201 patients); in the 10-day group, the eradication rate was 92 percent (189 of 205 patients). Post-treatment evaluation revealed clinical cure in 96 percent of patients in the five-day treatment group and 98 percent of patients in the 10-day treatment group.
The most common drug-related adverse events were nausea, vomiting, diarrhea and gastrointestinal discomfort. Drug-related adverse events occurred in 5 percent of the children in each group.
The authors conclude that a five-day course of cefuroxime is clinically and bacteriologically equivalent to a 10-day course in children with GABHS tonsillopharyngitis.