The most frequent bacterial cause of
pharyngitis/
tonsillitis, a common
infection in children, is group A beta-hemolytic streptococci. Prevention of
acute rheumatic fever is the principal goal of treatment, although
antibiotic therapy may also relieve the signs and symptoms of
infection, shorten the infective period and prevent suppurative complications.
Penicillin is the
drug of choice. Alternatives are required, however, for patients allergic to
penicillin and may be needed if the rate of bacteriologic failure with
penicillin observed during the past decade continues.
Erythromycin is generally effective in this
infection, but its use, especially in children, is complicated by the need for multiple daily doses, a lengthy treatment period and a high rate of gastrointestinal side effects. The newer
macrolides clarithromycin and
azithromycin offer lower rates of gastrointestinal complaints and more convenient dosing.
Clarithromycin is recommended for twice daily and
azithromycin for once daily administration. Because of its prolonged tissue half-life, the recommended duration of
azithromycin therapy is 5 days, compared with 10 days for
penicillin,
erythromycin and
clarithromycin. Newer
macrolides are rational alternatives to
erythromycin for streptococcal
pharyngitis/
tonsillitis in
penicillin-allergic patients.