Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice.

Abstract

BACKGROUND:

The effect of antibiotic therapy in sore throat is questionable and this dilemma has been complicated by the emergence of multiple resistant strains of micro-organisms.

AIM:

A randomized double-blind placebo-controlled clinical trial was undertaken in patients aged 4-60 years to assess the efficacy of penicillin V on the clinical course and bacteriological response in patients with sore throat in general practice.

METHOD:

Two hundred and thirty-nine patients presenting with an acute sore throat to 37 general practices in the Netherlands who were clinically suspected of group A beta-haemolytic streptococci (GABHS) were randomized for treatment with penicillin V (n = 121) or placebo (n = 118). Resolution of sore throat, fever and return to daily activities were evaluated by the general practitioner 2 days after the start of treatment and by the patients keeping a diary for 7 days. The result of throat culture after 2 days was evaluated.

RESULTS:

A difference in resolution of sore throat was present after 2 days in all patients, but was a result of GABHS-positive patients (n = 111; 46%) in favour of those randomized for penicillin V (adjusted odds ratio 5.3; 95% CI 1.9-15.1). An effect in the course of fever was also seen in GABHS-positive patients (adjusted odds ratio 5.3; 95% CI 1.02-27.7). A difference of 1-2 days was seen in clinical recovery. No difference was found in daily activities between the treatment groups. After 2 days, 4% of the penicillin-treated patients harboured GABHS compared with 75% of the placebo group.

CONCLUSION:

Only GABHS-positive patients benefit from penicillin V in their clinical cure in the first few days. Therefore, rapid testing is necessary. Treatment may be beneficial with regard to the clinical course, but it is not necessary.

• Authors: C F Dagnelie, Y van der Graaf, R A De Melker
• Journal: The British journal of general practice : the journal of the Royal College of General Practitioners (Br J Gen Pract) Vol. 46 Issue 411 Pg. 589-93 (Oct 1996) ISSN: 0960-1643 [Print] England
• PMID: 8945796 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Penicillins
• Penicillin V

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Double-Blind Method
• Family Practice
• Female
• Humans
• Male
• Middle Aged
• Penicillin V (pharmacology, therapeutic use)
• Penicillins (therapeutic use)
• Pharyngitis (drug therapy)
• Streptococcal Infections (drug therapy)
• Streptococcus pyogenes
• Treatment Outcome