Penicillin has been first-line
therapy for the treatment of streptococcal
pharyngitis for more than 40 years. Since the 1980s, there have been a number of reports suggesting that bacteriologic failure rates with
penicillin may be rising. A number of
alternative therapies have been proposed, including oral
cephalosporins. To evaluate the efficacy of these agents, two meta-analyses have recently been performed. In the meta-analysis performed by Pichichero and Margolis, oral
cephalosporins were reported to achieve a significantly greater bacteriologic cure rate than
penicillin (92% with
cephalosporins vs 84% with
penicillin, P < 0.0001) when results from 19 studies were analyzed. A separate meta-analysis performed by Deeter et al reported that the oral
cephalosporin cefadroxil monohydrate achieved significantly greater bacteriologic cure rates (94.8%
cefadroxil vs 87.5%
penicillin, P < 0.05) than oral
penicillin when 9 trials in 1406 patients with streptococcal
pharyngitis were analyzed. A review of 65 studies of the use of
penicillin for the treatment of streptococcal
pharyngitis has shown that bacteriologic failure rates in the period 1980 to 1993 were approximately 12% to 13%, slightly but not significantly greater than during the period 1953 through 1979. Oral
cephalosporins such as
cefadroxil monohydrate provide reasonable alternatives for the treatment of streptococcal
pharyngitis.