A COMPARISON OF CEPHALOSPORINS AND PENICILLINS IN THE TREATMENT OF GROUP-A BETA-HEMOLYTIC STREPTOCOCCAL PHARYNGITIS - A METAANALYSIS SUPPORTING THE CONCEPT OF MICROBIAL COPATHOGENICITY

Although penicillin has been the antibiotic of choice for therapy of Group A beta-hemolytic streptococcal pharyngitis for more than four decades, reports of bacteriologic and clinical treatment failures with penicillin have increased in recent years. We conducted a meta-analysis of 19 studies to examine whether oral cephalosporins were associated with lower failure rates than oral penicillin in the treatment of Group A beta-hemolytic streptococcal pharyngitis. The overall bacteriologic cure rate for penicillin was 84% (95% confidence interval (CI), 82%, 86%) compared with 92% (95% CI, 91%, 94%) among patients treated with cephalosporins (P < 0.0001). The overall clinical cure rate in the penicillin groups was 89% (95% CI, 87%, 91%) compared with 95% (95% CI, 94%, 96%) in the cephalosporin group (P < 0.001). There was no significant difference between the cephalosporins and the penicillins with respect to adverse events. There may be clinical circumstances in which treatment of Group A beta-hemolytic streptococcal pharyngitis with cephalosporins is indicated.