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Cefuroxime Axetil in Short-Course Therapy of Tonsillopharyngitis

A Pooled Analysis of 3308 Patients Receiving 5- or 10-Day Treatments Compared with 10-Day Oral Penicillin V

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Abstract

Background: Although 10 days’ treatment with oral penicillin V has been the standard recommended treatment for Group A β-haemolytic streptococcal (GABHS) tonsillopharyngitis for the last 40 years, shorter penicillin courses are not as effective. In contrast, short-course treatments with newer agents have been shown to be effective and to have similar efficacy to penicillin in preventing poststreptococcal sequelae.

Objective: To assess treatment outcomes and benefits of different durations of cefuroxime axetil therapy compared with a 10-day penicillin V regimen in streptococcal tonsillopharyngitis.

Methods: Literature searches (1987 to present) were undertaken to identify comparative studies of cefuroxime axetil versus penicillin V in the treatment of tonsillopharyngitis.

Results: Four studies, involving 1042 GABHS culture-positive patients in the USA, compared cefuroxime axetil twice daily for 10 days (n = 682 patients) with penicillin V three times daily for 10 days (n = 360 patients). Results of a pooled analysis indicated that GABHS eradication was superior in the patients treated with cefuroxime axetil (94%; 640/682) compared with those receiving penicillin (85%; 305/360). The weight-adjusted treatment difference of 9% [95% confidence intervals (CI) 4.3 to 13.7%] was significant in favour of cefuroxime axetil (odds ratio of successful treatment 2.7 relative to penicillin). Clinically there was also a significant treatment difference of 6.8% (95% CI 2.4 to 11.2%). Three European studies (n = 2266) compared 4- to 5-day cefuroxime axetil treatment with 10 days’ penicillin V in culture-positive tonsillopharyngitis. In the pooled analysis, eradication rates were 90% (604/668) for cefuroxime axetil compared with 85% (1357/1598) for penicillin V. The weight-adjusted treatment difference was 3.4% (95% CI—0.7 to 7.4%), indicating superiority of cefuroxime axetil treatment.

Conclusions: Pooled analyses confirmed the results of individual studies and highlighted the superiority of cefuroxime axetil given for 10 days or 4 to 5 days over 10 days’ penicillin V, both in the treatment of acute culture-proven tonsillopharyngitis. Importantly, short-course cefuroxime axetil is superior to the standard oral penicillin regimen. With increasing concerns about antibacterial usage, shorter treatment courses in this indication could be beneficial and used as alternatives to the penicillin reference treatment.

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Acknowledgements

The authors would like to acknowledge the assistance of Clara Marr and Heather Staley in the preparation of this manuscript and to thank Anna Regan for help with statistical analyses. The studies in the analysis were funded by Glaxo Wellcome.

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Authors and Affiliations

  1. Salt Lake City, Utah, USA

    Willis Manford Gooch

  2. Département d’ORL, Hôpital Bichat-Claude Bernard, Paris, France

    Pierre Gehanno

  3. Glaxo Wellcome Research and Development, 891-995 Greenford Road, Greenford, Middlesex, UB6 0HE, England

    Anne M. Harris

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  1. Willis Manford Gooch
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  2. Pierre Gehanno
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  3. Anne M. Harris
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Correspondence to Anne M. Harris.

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Gooch, W.M., Gehanno, P. & Harris, A.M. Cefuroxime Axetil in Short-Course Therapy of Tonsillopharyngitis. Clin. Drug Investig. 19, 421–430 (2000). https://doi.org/10.2165/00044011-200019060-00004

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